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CAPITAL DISTRIBUTORS(S) PTE LTD

21 Ubi Road 1, #01-01, Singapore 408724

Tel: 6288 9190 Fax: 6288 5869 Email : sales@capital.com.sg

ENQUIRY FORM

Section 1

To be completed.

1.1

Full Name

Dr Mr Mrs Mdm Ms

1.2

Company

Leave blank if you are ordering as an individual.

1.3

Address

1.4

Postal Code

1.5

Tel No.

Fax No.

PG / HP

1.8

E-mail

(Must be current valid e-mail address)
Any information related to this form will be sent to the above e-mail address.

Section 2

Please fill in the model(s) to order.

2.1

Model No.

Section 3

Your enquiry

3.1