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Name :
Address :
City :
Zip Code :
Country   :
Phone : Coun.code        Area code.          Phone no.
          
E-mail :

‘Diacare’ Order For :

 Four Months treatments  US $ 300
Eight Months treatments  US $ 600
Twelve Months treatments US $ 900 
Mode of Payment :
Wire Transfer
International Demand Draft

Send us  demand draft/wire transfer
in favour of :

Admark Herbals Limited
41, Binori Corner,
Nr. Shyam Prasad Mukherji Overbridge,
Jivraj Park , Ahmedabad - 380 051
Gujarat, India

Payments details :
( In case of demand draft )

Name of Bank 
D.D. No.
Amount
Date
Your Comments :

Note : I hereby agree to pay any duty payable on this medicine and if necessary obtains prior
permission from the appropriate authorities for import the same.

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