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*Name :
*Address1 :
*Address2 :
*Ward :
*Mobile :
Email :
*Prefered Delivery Date & Time :
*Tanker Type :
*No. of Tanker : X Rs.
Total amount you have to pay : : रु.
Reason :

1.टैंकर उपलब्ध होने पर ही भेजा जावेगा।

2.विवाद का न्याय क्षेत्र नगर पालिक निगम, दमोह होगा।

I hereby confirm that I have read and accept the terms and conditions.

 
     
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