PETROLEUMS PVT. LTD.
E-10 NANDDHAM IND. ESTATE.,
MAROL MAROSHI ROAD, ANDHERI (E)
MUMBAI (INDIA)
Tel: 91-22-2920 9201 Fax: 91-22-6693 8662
E-Mail : mytol@vsnl.net
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Following are the Form Details Submitted at mytolpetroleum

Your Name    : $Name
Company's Name : $Company
Address : $Address
Tel.No : $Telephone
Fax : $Fax
E-mail   : $Email
"; $msg .= "
     
AREA OF CONCERN
EQUIPMENT DETAIL
     
"; $msg .= "
Automotive Lubricants : $Automotive_Lubricants
Waxes & Jellies : $Waxes_Jellies
Metal Working Oils : $Metal_Working_Oils
Industrial Lubricants : $Industrial_Lubricants
Industrial Speciality Products : $Industrial_Speciality_Products
"; $msg .= "
     
DO YOU WANT :
     
  $Information
     
 
ORDER DETAILS:
 
"; $msg .= "
           
Sr.No.
Product
Packing
Price/Unit
Quantity (Ltr\Kg)
Total (in Rs.)
           
1
$Product1
$Packing_Product1
$Price_Unit_Product1
$Quantity_Product1
$Total_Price_Product1
2
$Product2
$Packing_Product2
$Price_Unit_Product2
$Quantity_Product2
$Total_Price_Product2
3
$Product3
$Packing_Product3
$Price_Unit_Product3
$Quantity_Product3
$Total_Price_Product3
4
$Product4
$Packing_Product4
$Price_Unit_Product4
$Quantity_Product4
$Total_Price_Product4
5
$Product5
$Packing_Product5
$Price_Unit_Product5
$Quantity_Product5
$Total_Price_Product5
 
TAXATION DETAILS:
   
Excise/Modvat
    
         
                              Is MODVAT Required ?        $Excise_modavt  
                    Is CT3 form facility available?        $Excise_modavt  
         
         
"; $msg .= "
C.E. Reg. No. : $CE_Reg_No
Range : $Range
Division : $Division
Collectorate : $Collectorate
E.C.C. No. : $ECC_No
    Sales Tax
     
"; $msg .= "
                                    Against C Form ?        $SalesTax  
                                  Against BC Form ?        $SalesTax  
         
"; $msg .= "
C.S.T Reg.No. : $CST_Reg_No
L.S.T. Reg. No. : $LST_Reg_No
PAN No. : $PAN_No
     
    DELIVERY DETAILS:
  :  
"; $msg .= "
Your Transporter : $Transporter
Contact Person (s) : $Contact_Person
Tel No : $Telephone_No
Delivery Site Address : $Delivery_Site_Address
Site Tel No : $Site_Tel_No
Site Fax No : $Site_Fax_No
Site working hours : $Working_Hours
Weekly off : $Weekly_off
     
    PAYMENT ADVICE:
     
$Payment
     
     
Cheque/Draft No : $Cheque_Draft_No
Bank : $Bank
Amount : $Amount
"; $msg .= "
                                
NB: Delay in Payment OR your Outstanding may delay the processing of your Order.
     
OTHER INSTRUCTIONS:
"; $msg .= "
                     Original Invoice to be sent to  $Invoice  
"; $msg .= "
Number of copies of invoice Reqd : $Invoice_Copies
"; $msg .= "
                                 Test Certificate Reqd  $TestCertificate  
"; mail("$to","Order/Enquiry from the website: MyTolPetroleum.com","$msg","From: $from\nContent-Type: text/html; charset=iso-8859-1"); echo "
Mail has been sent successfully

Your Name   * :
Company's Name :
Address :
Tel.No :
Fax :
E-mail  * :
     
AREA OF CONCERN
EQUIPMENT DETAIL
     
Automotive Lubricants :
Waxes & Jellies :
Metal Working Oils :
Industrial Lubricants :
Industrial Speciality Products :
     
DO YOU WANT : (PLEASE SELECT)
     
To know more about MYTOL
A representative to call on you to explain about MYTOL
     
ORDER DETAILS:
 
           
Sr.No.
Product
Packing
Price / Unit
Quantity (Ltr\Kg)
Total
(in Rs.)
           
1
2
3
4
5
 
TAXATION DETAILS:
Excise/Modvat
  
         
Is MODVAT Required ?                     Yes  No
  
Is CT3 form facility available?          Yes  No  
         
         
C.E. Reg. No. :
Range :
Division :
Collectorate :
E.C.C. No. :
 
SALES TAX
     
Against "C" Form ?          Yes  No
Against "BC" Form ?        Yes  No
       
C.S.T Reg.No. :
L.S.T. Reg. No. :
PAN No. :
     
DELIVERY DETAILS:
     
Your Transporter :
Contact Person (s) :
Tel No :
Delivery Site Address :
Site Tel No :
Site Fax No :
Site working hours :
Weekly off :
     
PAYMENT ADVICE:
     
Cheque/Draft attached with Purchase Order
sent through courier
paid through Sales Engineer
     
     
Cheque/Draft No :
Bank :
Amount :
                                
NB: Delay in Payment OR your Outstanding may delay the processing of your Order.
     
OTHER INSTRUCTIONS:
Original Invoice to be sent to    Site Office
 Main Office
Number of copies of invoice Reqd:
Test Certificate Reqd    Yes
  No  
                                
You may use the printout of this form for placing your order or may copy the above format on your letter head.