Paleti Subscription Form


Paleti Subscription Form
Yes, I wish to subscribe Paleti for 1 year
Date:
I agree to be a Paleti collacorate and would like to subscribe to the 'Paleti' series
Full Name:*
Address:
City:
Delivery Address:*
Date of Birth:*
Mobile:
Residence:
Office:
e-mail Address:*
P.O.Box:
I wish to pay by:*	Cash Cheque
Anual Membership Fee: Rs. 3000 Only.
(All cheques/drafts should be drawn in favor of A.S. Distribution and Marketing Pvt. Ltd.)
Validation Code: