BULK SMS ORDER Information FORM

Date: ___/___/2010 Sender ID: Sender ID Proof: ______

Name: ___________________ Mobile ________________________ Landline_____________________

Firm/s Name: __________________________________ Address: _______________________________

SMS UNITS Email ID

Rate Cheque No
Other Charges Cheque Date
Total Amount Bank Name

SMS TEXT Broadcast Date: ___/___/2010

Payment: ‘ NO CASH ‘ ONLY by A/c Payee CHEQUE/DD in Favor of CONNECT GLOBE.

Order acceptance subject to receipt of Payment. All disputes under Jodhpur Jurisdiction Court. SMS under norms of
TRAI & DOT, clients is responsible for content & sender id. For All terms & conditions refer to www.connectglobe.in

Comment/Other Instruction (Break Up, Multiple date etc) E &O.E. SIGN

Customer

Agent