DEBIT NOTE

Service Tax Regn. No. AAACI 1369MST001, PAN No.AAACI1369MPRICE LIST-CUM-ORDER FORMS. No.ParticularsRateQty. orderedAmount (Rs)

1Members directory on printed book1500.00

Total

To receive your copy, send this form along with payment by Demand Draft/Cheque only in favour of: Indian Machine Tool Manufacturers Association payable at Bangalore, to

Mr. Sreedhara,

Indian Machine Tool Manufacturers AssociationBangalore International Exhibition Centre

10th Mile, Tumkur Road, Madavara Post

Bangalore 562 123

Tel: +91 80 6624 6519E: sreedhara@imtma.in(Please allow four weeks for delivery)Details of ordering firm

Name of the company

:

Contact person

:

Contact details

:Address to which to be sent

:Payment details:

DD/Cheque No.dtdrawn on

Bank

(Signature) Date: