::: AKAS Medical Equipment ::: Order Form :::

ORDER FORM

To,

The Billing Division
AKAS Medical Equipment
L-102 A, L Block, Anna Nagar East,
Chennai - 600 102. INDIA.
Tel No: 044-55449911,
Fax No: 044-26633227,
Mobile No. 9383050005,
Email: sales1@akasmedical.com

Hospital name *		Invoice name *
Address *

City *		Zip code/Pin code *
State		Country

Contact person *

Designation *
Tel No(s)/Fax *
Mobile
Email *

Pick your Orders
	Model Code	POC (Product ordercode)	QTY	UNIT RATE	TOTAL AMOUNT





				Net Total

Payment terms
Advance Payment : Rs.

on Delivery / installation: Rs.

Payment should be made in the favour of "AKAS Medical Equipment A/C sales1".
Advance payment Details: Cheque / DD no.
Date:

Cash payments are strictly not allowed

Despatch Information

Same as above

Despatch Address:

City:

Pin:

Tel No(s):

State:

Country:

Mobile:

Payment Details

If the order value is < 1 lakh 100% DD.

If the order value is > 1 lakh 25% Advance DD, 75% on COD

In favour of "AKAS Medical Equipment A/C sales1"

Associate:

Any special Instructions:

Order booked by:

Date :

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