purchase order form

Please order through the form below. “ We regret to say that we are unable to respond to any orders via telephone.” However, you can fax or email your order. Once we receive your payment, we will dispatch your order within 48 hours.

(If there is any problem with the form below: please contact us at teamprantik@gmail.com )

* Full Name:
* Mailing Address:	* Address * State/Province * Postal Code: * Country: * Email Id: * Telephone: Fax:
Complete Package:	Yes No
Individual Products:	Yes No
Product Needed: Quantity Needed: Package Preferred: (Examples - 100ml bottles, 2x5 lts cans, 1x5 lts cans & 2x100ml) 1. 2. 3.
* Payment Details :	Cheque Demand Draft
Further Clarifications :

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