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file:///C:/00terapanth/club/amazing_m_form.txt
Jaindhram.com
Jain Amazing Club
Member Enrolment Form
( This Form to be send by Email,Mail or By Fax )
Send enrollment form by mail to Jaidhram.com. Paper Box
house. Mahakali Caves Road. Andheri-East. Post Box No. 9434
.Bombay- 400 093 ( India ) or by email to club@jaindhram.com
* optional all remain required.
First Name ______________ Last Name ______________
Email address _____________________________________
What Name to be used while sending your message. ( Example: With
Best Compliments From Rajesh or Mr. & Mrs. Rajesh or Rajesh &
Rajani or Rajesh,Rajani & Sonu, Bunty etc. )
______________________________________________________
* Any subsequent email for BCC ___________________________
Age: ______ Yrs. Sex: [] Male [] Female
Address: ___________________________________________
City: _____________________________________________
State / Prov: ____________________________
Country: _______________________________
Postal Zip: __________________
Phone & Fax Number: _________________________________
* Best Time to Contact you ( In Your Local Time )
_____am/pm to_____ am/pm By [] email [] fax [] Phone
* Your Address in India ( Write detail with phone number etc.)
___________________________________________________________________
Select Services you Select
[] TS-01 [] TS-02 [] TS-03 [] TS-04 [] TS-05
[] TS-06 [] TS-07 [] TS-08 [] TS-09 [] TS-10
S Cod Service Unit Particular's
. e
N
___________________________________________________________
0 TS- Samatsavr 10 Ichami Dukdam ( Khamat
1 01 i Card Address Khvana ) will posted 2nd
day of Samatsvari Ichami
Dukdam ( Khamat Khvana )
will posted 2nd day of
Samatsvari
0 TS- Dipawali 10 Dipawali Greetings. Will
2 02 Card Address be posted before 3 days
Dipawali Greetings. Will
be posted before 3 days
0 TS- New Year 10 Will be Posted on every
3 03 Card Address 26th of December
0 TS- Chrisms 05 Will Be Posted on every
4 04 Address 22nd of December
0 TS- Rakhi's 5 Persons With traditional Roli,
5 05 tikka powder, Rice and
500 gms. Sweet Box.
0 TS- Bouquet 2 address On Occasions :
6 06 Anniversary or Wedding.
You need to inform seven
days in Advance.
0 TS- Bouquet 2 address On Occasions of
7 07 Birthday. You need
inform seven days in
advance.
0 TS- Born baby 1 address Born baby Gift hampers.
8 08 12 Born baby ( 8 are
Johnson make ) item
decorated into a
basket.. Carrying your
massage.
0 TS- Good Luck 5 address Good Look Card for
9 09 examination or wherever
you feel.
1 TS- Congratul 5 address Congratulations Cards on
0 10 ations various occasions.
Wherever you feel.
Service TS-01 To TS-05
Address's
Message:
Services: [] [ TS-01 ] [] [ TS-02 ] [] [ TS-03 ]
[] [ TS-04 ] [] [ TS-05 ]
( Please Repeat Above as per your Requirement )
Service TS-06
( If You have information Please write otherwise write After in
Remark Column )
Address's
Message:
Occasions:
Date & Detail:
Remark:
( Please Repeat Above as per your Requirement )
Service TS-07
( If You have information Please write otherwise write After in
Remark Column )
Address's
Message:
Occasions:
Date & Detail:
Remark:
( Please Repeat Above as per your Requirement )
Service TS-08
( If You have information Please write otherwise write After in
Remark Column )
Address's
Message:
Occasions:
Date & Detail:
Remark:
( Please Repeat Above as per your Requirement )
Service TS-09
( If You have information Please write otherwise write After in
Remark Column )
Address's
Message:
Occasions:
Date & Detail:
Remark:
( Please Repeat Above as per your Requirement )
Service TS-10
( If You have information Please write otherwise write After in
Remark Column )
Address's
Message:
Occasions:
Date & Detail:
Remark:
( Please Repeat Above as per your Requirement )
( You can also format Form with your convenience. What We means
is correct information. )
*Are You enrolling Three or more as a Group if Yes Please place
the Name of another person.
If Yes Specify name and email address:
_________________________________________________
What User/ reference name you would like __________________
( This will be your separate folder/File and you need to write
this in all your future communication )
How You are settling Payment
( Please see payment option detail below this form )
[] By Credit Card [] By Money order / Check [] By Wire
Transfer
· Your any Special comment , remark or suggestion's.
______________________________________________________
______________________________________________________
______________________________________________________
Name of The Member __________________ Date:_______________
************************
Payment option :
1st: Credit Card. At this moment We accept American Express ,
Master Cards & Visa
( Following Card You need to Fax us With Your Signature & Detail
)
Your Card Detail are the Secret Detail For Jaindhram.com and
will not be mis use in any manner.
Card Holders name and address
To,
Cyber Booth
PaperBox House,
Mahakali Caves Road,
Andheri (East),
Mumbai - 400 002,
India.
Date:-____________
Dear Sir,
I would like to place an order for services etc amounting to
US$/ Rs. _______(In figure ).I request you
to debit my card a/c,details of which are as under:-
Card No:-______________________________________________
Expiry Date:-______________________________________
Card Holder's Name:-____________________________________
Amount in Rupees/ US$:-_______________________________________
Thanking You
Yours Faithfully
(Signature of Card Holder)
Also send us the additional information along with the
above letter.
Name :
Passport Number :
Home Phone Number :
Billing Address :
Social Security Number :
Mother's Maiden Name :
Color of the Card :
Bank Name on the Card :
Name of the joint account Holder :
Date of Birth :
Kindly fax us the above letter on your personal
letterhead on fax Number (91-22-8215249 OR 91-22-6231958)
2nd: Pay by Money Order,By Demand Draft,check Etc.
Payment in Indian Rupees: Checks,Drafts, Money Order should be
payable in Bombay in favor to Jaindhram.com.
Payment in US $ : To be payable in US in favor to Jaindhram.com
And to be mail : Jaindhram.com.
Paper Box House. Mahakali Caves Road. Andheri-East. Post Box No.
9434. Bombay-400 093 ( India ) Tel: 91-(0)22-8219665,8327092 Fax:
91-(0)22-8215249 or 6231958
3rd: By Wire Transfer:
HDFC BANK LTD.
Andheri-West. Link Road. Bombay-400 093 ( India )
Code: 0011406717 A/C HDFC BANK LTD.
Swift: CASHUS33 Further Credit to A/C Jaindhram.com a/c No.
0192000002034