INSTRUMENT ORDER FORM

Details of the Distributor

Name of Distributor
Contact Person
Address
Landmark
City
PIN
Email
Contact No.
Details of the Instrument Order
Instrument Name Qty Rate/unit Total Value (Excl. of taxes)
SPHERA
ACCULAB AT300D
ACCULAB Enlite
ACCULAB CBC360+
ACCULAB CBC330
Urit 30
1

Free Goods apart from 2

startup reagents 3

4
Advance: Rs.
Payment Terms
(Mention amount in Rs.)
COD to be applied (Yes/No):
No. of PDCs:
PDC 1 details (Cheque No.) (Amount) (PDC date)
PDC 2 details (Cheque No.) (Amount) (PDC date)

TOTAL

Others Remarks

Distributor Stamp & Sign:

Date:

Accurex Biomedical Pvt. Ltd.

212, Udyog Mandir No. 1, 7/C, Bhagoji Keer Marg, Mahim (W), Mumbai - 400 016
Tel.: +91 (22) 6744 6744; Email: info@accurex.net
Call us Toll Free: 1800 209 8456