Title:
Mr Ms Mrs M/s
Name:
Residence Address:
Dist:
State: Occupation:
Tel:(_____) Res(:_ _ _ _ _) Fax:
Code Code
Mobile No: Email:
Please Tick The Appropriate Product Colour TV B&W TV DVD Washing M/C. AC Plasma TV Rear Projection TV
Microwave Oven LCD TV
Model No:
Serial No
Please Refer Sticker On Back Cover Of Your Product
Purchase Date
Day Month Year
Bill No.
I Accept The Terms And Conditions of The Warranty Customer Signature
Thank you for selecting a World Class product and we assure you that it will perform as per your expectations
We thank you for taking your time to complete this form. All Information Provided by You will be Kept Confidential.
(Ple a se Fill In, Te a r o ff, Fo ld a nd Ma il this fo rm to Re a c h us within 10 da ys o f the Pro d uc t Purc ha se .)
We welcome your Valuable Suggestions, if any, to Improve our Products and Services :
FOR OFFICE USE ONLY
Customer Code:
MIRC Electronics Limited
Warranty Card
Customer Details
Product Details
Serial No.
Customer Copy
Pin:
Branch:
Mirc Electronics Ltd.
Note: Company Will Not Be Responsible For The Loss Of This Form During Transit. Fo r O the r De tails o n O ur Pro d uc ts & Se rvic e s Lo g O n To w ww.o nid a .c o m
Dealer’s Name & Address
Signature
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