Buy Dialysis Frequent Plan Registration Form

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DIALYSIS FREQUENT

Name *

Mobile *

Date Of Birth *

Gender *

Male Female

Email *

Pincode *

Address1 *

Address2

State *

City *

Monthly

Yearly

Special Price (Rs.): Approx. 35% Off
1400/month x 12 months = ~~16800~~
1400/month x 12 months = 11000

IGST @18% (Rs.):

Grand Total (Rs.):

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