Documente Academic
Documente Profesional
Documente Cultură
Ltd
CIN – U41000TN2015PTC100366
Regd. Off: No.55, Thandalam Vill.Sriperumbadhurt Taluk,Kancheepuram, Chennai TN 602 105 .
Corp. Office: The Millenia Tower B, 4th Floor, Unit 401 No. 1 & 2, Murphy Road, Ulsoor, Bangalore 560-008. India.
FORM-PO-09-IND www.enagic.co.in | Ph: 080 46509900 | Fax: 080 46509908
PRINCIPAL INFORMATION
Please tick one your category (P)
Individual Sole Proprietorship Partnership Firm Private Limited Company Others (Please provide details)
Kindly give name of the legal entity (the Entity) formed solely to complete this preferred customer application form
Name
Residency Status (only applicable to individual applicants) Citizen of and resident in India
13 0 7 1 9 8 6
ADDRESS DETAILS
Please provide your complete postal address with pin code and attach a valid address proof along with this application form. Your application will be rejected without valid address proof.
SWASTIK SOCIETY
MORABI RAJKOT
RAJKOT
363641 GUJRAT.
9586323232
livecityceramicpvtltd@gmail.com
PRODUCTS OFFERED Please check product availability before submitting Purchase Order Form
PRODUCTS [ please tick (P) ] SERIAL NO. (office use only) UNIT PRICE (INR) (P)
LEVELUK JRII `. 1,55,000.00
LEVELUK ANESPA DX `. 2,00,000.00
LEVELUK SD501 `. 2,77,000.00
LEVELUK SD501 PLATINUM `. 2,97,000.00
LEVELUK K8 `. 3,43,000.00
LEVELUK SUPER 501 `. 3,97,000.00
Please do check Statutory Form requirement of your state with
SHIPPING CHARGES service/customer desk before proceeding your shipment PAYMENT METHOD
ZONE ZONE CLASSIFICATION BLUE DART DTDC CHEQUE NO: _____________________________________________
SOUTH AP, Telangana, Karnataka, Pondicherry, Kerala, Tamilnadu 1800 1100 CHEQUE DEPOSIT DATE: __________BANK:___________________
WEST Gujarat, Goa, Maharashtra, Madhya Pradesh, Chhattisgarh 2200 1500 CREDIT CARD (single payment)
NORTH Chandigarh, Delhi, Haryana, Himachal Pradesh, CREDIT CARD-INSTALLMENT: [ ] Month/Bank Name:
Punjab, Rajasthan, Uttar Pradesh, Uttarakhand 2600 2000 NEFT RTGS IMPS
EAST Bihar, Jharkhand, Orissa, West Bengal 3100 2000 Enagic Instalment Plan/NACH- 10 Months 20 Months
NORTH EAST Arunachal Pradesh, Assam, Manipur, Tripura,
Meghalaya, Mizoram, Nagaland, Sikkim 3400 2000 *KINDLY SHARE ACKNOWLEDGEMENT COPY OF PAYMENT AND
J&K Jammu and Kashmir 3400 3000 REFERENCE NUMBER
Portabliar Andaman& Nicobar Island / Special Destination 3000 2000