MedPRACTICE Software Purchase Order Form
Print & fill this form and send to Capitol Business Services Pvt. Ltd. Capitol Business Services Pvt. Ltd, Second Floor, P.K Complex, R.C Road, Calicut, Kerala-673032 Tel:91-495-2367790 Fax-91-495-4015650 Email-sales@MedCLIK.com Website-WWW.MedCLIK.com
Order Details Name Address
City State Pincode Telephone # Email Payment mode DD / Cheque no. VPP Product Pricing: Package – MedPRACTICE single copy for single System. Price - Rs 5950/Outstation Cheque Collection charge only Rs 35/Please make sure that the above address is correct. Note: US $150 for all Overseas purchase.
Payments should be made in favour of
Capitol Business Services Pvt Ltd, payable at Place: Date:
Calicut, Kerala
(Signature)