Order Form

Consumer Unity & Trust Society 
D-217, Bhaskar Marg, Bani Park, 
Jaipur 302 016, Rajasthan, India
Ph:   +91(0)141-228 2821-3 
Fax: 91.141.2282485 
Email: cuts@cuts.org
cutsjpr@sancharnet.in

1. ORDERED BY:          

Name ___________________________________________________________

Organisation ___________________________________________________

Mailing Address ________________________________________________

City/State/Province ____________________________________________

Country/Postal Code ____________________________________________

Telephone (____) _______________  Fax (____) _______________

 

2 METHOD OF PAYMENT:

__ US$  

__ Indian Rs.

All payments should be in made by account payee cheque or demand draft, and in the favour of: Consumer Unity & Trust Society

3 SHIP TO: (If different from name and address shown above)

Name ___________________________________________________________

Organisation ___________________________________________________

Mailing Address ________________________________________________

City/State/Province ____________________________________________

Country/Postal Code ____________________________________________

Telephone (____) _______________  Fax (____) _______________

4 YOUR ORDER: (please print clearly or type)

 

Qty. |  Stock #  |        Title        |  Price     |  Price   |

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     |           |                     |  RS        | US$      |

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     |           |                     |  RS        | US$      |

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     |           |                     |  RS        | US$      |

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     |           |                     |  RS        | US$      |

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                                        Total Order | RS/US$      |

(Please attach additional sheet, if necessary)      |----------|

        PLEASE ADD 20% OF THE PRINTED PRICE FOR POSTAGE

THANK YOU FOR YOUR ORDER! 

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