Purchase Order For Software by jessifer

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									             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           Calicut, Kerala

Place:

Date:                                                        (Signature)

								
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