Enagic India Kangen Water Pvt.

Ltd CIN — U41000TN2015PTC100366

Regd. Off: No.55, Thandalam Vill.Sriperumbadhurt TaIuk,Kancheepuram, Chennai TN 602 105 .
Enogic” Corp. Office: The Millenia Tower B, 4th Floor, Unit 401 No. 1 & 2, Murphy Road, Ulsoor, Bangalore 560-008. India.
FORM•PO•09•IND
www.enagic.co.in I Ph: 080 46509900 | Fax: 080 46509908

PRODUCT PURCHASE ORDER FORM

NOTE: Please Complete this Purchase order form to purchase products of Enagic India Kangen Water Private Limited (hereinater’EnagicIndia' or'Company'). Applicant must be 18 years of age or above. All sections
are mandatory unless otherwise indicated.
Customer ID# For office use only
for office use only

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PR0DUCTS[pTeasetickQ )) SERIAL N0. (office use of/y) UNIT PRICE (INR)(Inclus )e ofGST)
LEVELUKJRII T. 1,55,H0.J0
LEVELUKANESPADX T. 2,0J,H0.J0
LEVELUKSD501 T. 2,77,010.J0
LEVELUKSD501PLATINUM T. 2,97,010.J0
LEVELUKK8 T. 3,43,690.60
LEVELUKSUPER501 T. 3,97,090.60

ZONE ZONE CLASSIFICATION BLUE DART CHEQUE NO:

DTDC
CHEQUE DEPOSIT DATE: BANK:
SOUTH AP, Telangana, Karnataka, Pondicherry, Kerala, Tamilnadu 1800 1100
WEST Gujarat, Goa, Maharashtra, Madhya Pradesh, Chhattisgarh 2200 f |1500 CREDIT CARD (single payment)
CREDIT CARD-INSTALLMENT: [ ] Month/Bank Name:
NORTH Chandigarh, Delhi, Haryana, Himachal Pradesh,
Punjab, Rajasthan, Uttar Pradesh, Uttarakhand 2600 2000 NEFT RTGS IMPS
Enagic Instalment Plan/NACH- 10 Months 20 Months
EAST Bihar, Jharkhand, Orissa, West Bengal 3100 2000
NORTH EAST Arunachal Pradesh, Assam, Manipur, Tripura, *KINDLY SHARE ACKNOWLEDGEMENT COPY OF PAYMENT AND
Meghalaya, Mizoram, Nagaland, Sikkim 3400 2000
REFERENCE NUMBER
J&K Jammu and Kashmir 3400 3000
Portabliar Andaman& Nicobar Island / Special Destination 3000 2000