ORDER FORM

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Music Today
Living Media India Limited
Hamilton House
1-A Connaught Place
New Delhi -110001
India

Date____________

Please arrange to send the following Audio Tapes/ Compact Discs:

Catalogue No Title name Audio Tapes(Nos) CDs (Nos) Value
         
         
         
         
         
         
Total        

 

My particulars (In Capital letters)

Name ____________________________________________________________

Address__________________________________________________________

City________________________  INDIA  PIN ___________________________

Tel number_____________________

My email_________________________________________________________

a)Cheque/ Draft no ________________________________Date     ___________

drawn on _____________________________________________ (Name of Bank)

for Rs ____________________________________ in Favour of Living Media India Ltd. at New Delhi

OR

b)Please charge my Credit Card

˜ Mastercard ˜ Visa   ˜ American Express

Credit Card no :˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜

Card Members name ______________________________________________________________

Card members signature__________________________________________

Card expiry date ________________________________________________

Please deliver the cassettes and /or CDs ordered by me to:

Name __________________________________________________

Address_________________________________________________

City__________________________INDIA  PIN______________________

Tel number_________________________

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