01. Customer Name :

02. Mobile Number :

03. Trial (or) First Order Duration :
7-Days15-Days30-Days

04. Preferred product :
Sampoorna Milk (₹30/500ml.)Lowfat Slim Milk (₹28/500ml.)

05. Delivery type/frequency :
Standard daily deliveryAlternative days delivery

06. Quantity per delivery (in Liters) :
0.5L1.0L1.5L2.0L2.5L3.0L3.5L4.0L4.5L5.0L5.5L6.0L6.5L7.0L7.5L

07. Select start date :

08. Delivery area name :

09. Location Identifier :

10. Postal Address :

11. Order Note :

12. Preferred Mode of Payment :
Online PaymentCheque PaymentCash Payment

13. How did you know about us?
Google SearchFriends/FamilyNews Paper adsOur Staff Meetup