Products Enquiry/Order Form
Questions marked by * are required.
1. Name of Product Ordered *
2. Packing Quantity *
3. No. of Pouches / Bottles required *
4. Amount intended to be paid. (Price: Panchgavya 5ml Rs.700, DFA CMB 400mg in 60ml Bottle Rs.210, Dsalt 5grams Rs,800 *
5. Desired mode of Payment
6. Your Name *
7. Email: *
8. Full Postal Address with Pin Code *
9. Mobile/Phone Number *
10. What Courier service is operating in your location? *
  • Professional Courier
  • Shree Tirupati Couriers
  • Delhivery Couriers
11. Do you want to become an Agent for Our Products?
12. Any other Information/Suggestions *