Please Submit one of the Coupons to your Moving Supervisor on the date of commencement of Packing to avail of discount Note :- Fields marked * are compulsory to be filled.

Name *
Company *
Address 1 *
Address 2
City *		Pin
Select a Country *	Select One Australia Austria Algeria Argentina Bahrain Bangladesh Belgium Bhutan Brazil Bulgaria Burma Canada Chile China Colombia Cuba Czechoslovakia Denmark Germany Egypt Ethopia Fiji Finland France Greece Hawai Hong Kong Hungry Iceland India Indonesia Iran Iraq Ireland Italy Jamaica Japan Jordon Kenya North Korea Kuwait Libya Macao Malasia Malta Mangolia Mauritius Morocco Nepal Netherland Newzealand Nigeria Norway Oman Pakistan Panama Peru Phillipines Poland Portugal Qatar Romania Saudi Arabia Singapore South Africa South Korea Spain Srilanka Sweden Switzerland Taiwan Tanzania Thailand Turkey Uganda UAE USA USSR UK Vietnam Venezuela Yaman Yugoslaviya Zambia Zimbabwe OTHER
E-Mail *
Telephone
Fax
When Should we contact	Immediately Later On Date Time
Did you qualify for 5% Discount	Yes No
Did you use any Mover in past	Yes No
If Yes provide Name
Your last moving experience
Comments *

Thank you for filling out this form.
We will donate US$1 on your behalf to a charity of your choice. Please indicate your preference.

Mother Teresa's Fund    Red Cross Fund
Chief Minister's Relief Fund    Prime Minister's Relief Fund
Any other (Please specify)

    

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