::: AKAS Medical :::

ORDER FORM

To,

The Billing Division
AKAS Medical
240/1, Periya Colony, Athipet, Ambattur,
Chennai - 600 058. INDIA.
Tel No: +91-44-3253 3333,
Fax No: +91-44-2635 0030,
Mobile No. +91-98403 79116,
Email: sales@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".
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"

Associate:

Any special Instructions:

Order booked by:

Date :