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DISTANCE LEARNING COURSES
Those Fields Which Are Marked
*
Are Mandatory
Name Of Course*
:
Select Course
Book Mark
";
Full Page(Color)
";
Back Cover
";
Inside Front Cover
";
Inside Back Cover
";
Full Page(B & W)
";
Half Page
";
Course Fee
:
Rs:
Shipping Charges
:
Rs:
Total Fees
:
Rs:
COMPANY INFORMATION -(Fill the Name Exactly as you want to appear on your Certificate)
Last Name*
:
First Name*
:
Initial
:
Company*
:
Company Address*
:
City*
:
State*
:
Country*
:
Zip Code*
:
Company Phone*
:
Company Fax
:
E-mail*
:
Present Position*
:
Social Security Number
:
Mode Of Payment*
:
Select Mode Of Payment
Cheque
Demand Draft
Credit Card
*Username
:
*Password
:
SHIPPING INSTRUCTIONS -
Company
:
Shipping Address*
:
City
:
State
:
Country
:
Zip Code
:
Home Phone
:
NOTE : In favour of "ASSOCOM-INDIA
PVT. LTD
.". (Kindly add Rs. 45/- if cheque is not payable at New Delhi).
*In case of credit card payment 7% of the total cost will be charged as credit card processing.
