Sri Lanka CD order form

Order Form

Fill in following form to place the order from Lanka $hop

If you would like to pay buy using a cheque or money order please print this form , fill it with payment info and mail it to
Digital Research, #72/6,Old Kesbewa Road,Gangodawilla,Nugegoda, Sri Lanka
or Fax it to +94-75-525522

Name
Company
Designation
E-Mail Address
Phone
Fax		Special Comments
Mailing Address

	Special price is Rs. 1500/= + Mailing & Handling Fees Rs. 350/= (US $ 19.00 + US $ 4.50)
I wish to Order	Units of SLCD for each SL Rs. 1850/= inclusive of mailing and Handling
Card Type
Card Number
Expiry Date
Mothers Maiden Name

Conditions
1. Sri Lanka CD will be mailed to you once the payment has been made and verified.