amicalifescience.com Open in urlscan Pro
103.145.51.107 Public Scan

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Submitted URL:
http://amicalifescience.com/
Effective URL:
https://amicalifescience.com/
Submission: On May 21 via api (May 21st 2024, 6:11:35 pm UTC) from US — Scanned from DE

Form analysis
3 forms found in the DOM

POST /#wpcf7-f1275-o1

<form action="/#wpcf7-f1275-o1" method="post" class="wpcf7-form init" novalidate="novalidate" data-status="init">
  <div style="display: none;">
    <input type="hidden" name="_wpcf7" value="1275">
    <input type="hidden" name="_wpcf7_version" value="5.5.6.1">
    <input type="hidden" name="_wpcf7_locale" value="en_US">
    <input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f1275-o1">
    <input type="hidden" name="_wpcf7_container_post" value="0">
    <input type="hidden" name="_wpcf7_posted_data_hash" value="">
  </div>
  <div class="row mb-4">
    <div class="col-md-4">
      <label>Stockists Name</label><br>
      <span class="wpcf7-form-control-wrap text-830"><input type="text" name="text-830" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
    <div class="col-md-4">
      <label>Executive Name</label><br>
      <span class="wpcf7-form-control-wrap text-831"><input type="text" name="text-831" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
    <div class="col-md-4">
      <label>Booking Date</label><br>
      <span class="wpcf7-form-control-wrap date-848"><input type="date" name="date-848" value="" class="wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date" aria-required="true" aria-invalid="false"></span>
    </div>
  </div>
  <div class="row mb-4">
    <div class="col-md-4">
      <label>DL No:</label><br>
      <span class="wpcf7-form-control-wrap text-832"><input type="text" name="text-832" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
    <div class="col-md-4">
      <label>GST No:</label><br>
      <span class="wpcf7-form-control-wrap text-833"><input type="text" name="text-833" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
    <div class="col-md-4">
      <label>Phone Number</label><br>
      <span class="wpcf7-form-control-wrap tel-445"><input type="tel" name="tel-445" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel" aria-required="true"
          aria-invalid="false"></span>
    </div>
  </div>
  <div class="row mb-4">
    <div class="col-md-12">
      <label class="tab-label"> Choose Your Products:</label>
    </div>
    <p><br></p>
    <div class="col-md-6">
      <div class="col-md-7 mb-4"><label class="tab-label">AMETONE TAB</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-844"><input type="text" name="text-844" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMETONE Junior 200ML SYP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-845"><input type="text" name="text-845" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMETONE 200ML SYP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-846"><input type="text" name="text-846" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEREST CC Tab</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-847"><input type="text" name="text-847" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEREST CC 100ML SYP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-848"><input type="text" name="text-848" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEREST LS 100ML SYP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-849"><input type="text" name="text-849" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEQUEEN 200 TAB</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-850"><input type="text" name="text-850" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEQUEEN OZ TAB</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-851"><input type="text" name="text-851" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECLAV-625 Tab</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-852"><input type="text" name="text-852" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">DIOO GEL</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-853"><input type="text" name="text-853" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECOBAL-OD</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-854"><input type="text" name="text-854" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
    </div>
    <p><!---Set1----------------></p>
    <div class="col-md-6">
      <div class="col-md-7 mb-4"><label class="tab-label">AMECOBAL 5G</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-855"><input type="text" name="text-855" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECOBAL-INJ</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-856"><input type="text" name="text-856" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEPAN-40</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-857"><input type="text" name="text-857" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEPAN-DSR</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-858"><input type="text" name="text-858" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEMOL-P</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-859"><input type="text" name="text-859" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEMOL-SP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-860"><input type="text" name="text-860" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECET-LC</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-861"><input type="text" name="text-861" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECET-AM</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-862"><input type="text" name="text-862" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEZEE-250MG</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-863"><input type="text" name="text-863" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEZEE-500MG</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-864"><input type="text" name="text-864" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
    </div>
  </div>
  <div class="row mb-4">
    <div class="col-md-12">
      <input type="submit" value="Send" class="wpcf7-form-control has-spinner wpcf7-submit"><span class="wpcf7-spinner"></span>
    </div>
  </div>
  <input type="hidden" class="wpcf7-pum" value="{&quot;closepopup&quot;:false,&quot;closedelay&quot;:0,&quot;openpopup&quot;:false,&quot;openpopup_id&quot;:0}">
  <div class="fusion-alert alert custom alert-custom fusion-alert-center wpcf7-response-output alert-dismissable" style="border-width:1px;"><button type="button" class="close toggle-alert" data-dismiss="alert" aria-hidden="true">×</button>
    <div class="fusion-alert-content-wrapper"><span class="fusion-alert-content"></span></div>
  </div><input type="hidden" name="pum_form_popup_id" value="1265">
</form>

POST /#wpcf7-f1277-o2

<form action="/#wpcf7-f1277-o2" method="post" class="wpcf7-form init" novalidate="novalidate" data-status="init">
  <div style="display: none;">
    <input type="hidden" name="_wpcf7" value="1277">
    <input type="hidden" name="_wpcf7_version" value="5.5.6.1">
    <input type="hidden" name="_wpcf7_locale" value="en_US">
    <input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f1277-o2">
    <input type="hidden" name="_wpcf7_container_post" value="0">
    <input type="hidden" name="_wpcf7_posted_data_hash" value="">
  </div>
  <div class="row mb-4">
    <div class="col-md-6">
      <label>Stockists Name</label><br>
      <span class="wpcf7-form-control-wrap text-930"><input type="text" name="text-930" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
    <div class="col-md-6">
      <label>Booking Date</label><br>
      <span class="wpcf7-form-control-wrap date-948"><input type="date" name="date-948" value="" class="wpcf7-form-control wpcf7-date wpcf7-validates-as-date" aria-invalid="false"></span>
    </div>
  </div>
  <div class="row mb-4">
    <div class="col-md-4">
      <label>DL No:</label><br>
      <span class="wpcf7-form-control-wrap text-932"><input type="text" name="text-932" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
    <div class="col-md-4">
      <label>GST No:</label><br>
      <span class="wpcf7-form-control-wrap text-933"><input type="text" name="text-933" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
    <div class="col-md-4">
      <label>Phone Number</label><br>
      <span class="wpcf7-form-control-wrap tel-945"><input type="tel" name="tel-945" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel" aria-required="true"
          aria-invalid="false"></span>
    </div>
  </div>
  <div class="row mb-4">
    <div class="col-md-12">
      <label class="tab-label"> Choose Your Products:</label>
    </div>
    <p><br></p>
    <div class="col-md-6">
      <div class="col-md-7 mb-4"><label class="tab-label">AMETONE TAB</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-844"><input type="text" name="text-844" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMETONE Junior 200ML SYP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-845"><input type="text" name="text-845" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMETONE 200ML SYP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-846"><input type="text" name="text-846" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEREST CC Tab</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-847"><input type="text" name="text-847" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEREST CC 100ML SYP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-848"><input type="text" name="text-848" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEREST LS 100ML SYP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-849"><input type="text" name="text-849" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEQUEEN 200 TAB</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-850"><input type="text" name="text-850" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEQUEEN OZ TAB</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-851"><input type="text" name="text-851" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECLAV-625 Tab</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-852"><input type="text" name="text-852" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">DIOO GEL</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-853"><input type="text" name="text-853" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECOBAL-OD</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-854"><input type="text" name="text-854" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
    </div>
    <p><!---Set1----------------></p>
    <div class="col-md-6">
      <div class="col-md-7 mb-4"><label class="tab-label">AMECOBAL-5G</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-855"><input type="text" name="text-855" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECOBAL-INJ</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-856"><input type="text" name="text-856" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEPAN-40</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-857"><input type="text" name="text-857" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEPAN-DSR</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-858"><input type="text" name="text-858" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEMOL-P</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-859"><input type="text" name="text-859" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEMOL-SP</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-860"><input type="text" name="text-860" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECET-LC</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-861"><input type="text" name="text-861" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMECET-AM</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-862"><input type="text" name="text-862" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEZEE-250MG</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-863"><input type="text" name="text-863" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
      <div class="col-md-7 mb-4"><label class="tab-label">AMEZEE-500MG</label></div>
      <div class="col-md-5 mb-4"><span class="wpcf7-form-control-wrap text-864"><input type="text" name="text-864" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="0"></span></div>
    </div>
  </div>
  <div class="row mb-4">
    <div class="col-md-12">
      <input type="submit" value="Send" class="wpcf7-form-control has-spinner wpcf7-submit"><span class="wpcf7-spinner"></span>
    </div>
  </div>
  <input type="hidden" class="wpcf7-pum" value="{&quot;closepopup&quot;:false,&quot;closedelay&quot;:0,&quot;openpopup&quot;:false,&quot;openpopup_id&quot;:0}">
  <div class="fusion-alert alert custom alert-custom fusion-alert-center wpcf7-response-output alert-dismissable" style="border-width:1px;"><button type="button" class="close toggle-alert" data-dismiss="alert" aria-hidden="true">×</button>
    <div class="fusion-alert-content-wrapper"><span class="fusion-alert-content"></span></div>
  </div><input type="hidden" name="pum_form_popup_id" value="1267">
</form>

POST /#wpcf7-f1239-o3

<form action="/#wpcf7-f1239-o3" method="post" class="wpcf7-form init" novalidate="novalidate" data-status="init">
  <div style="display: none;">
    <input type="hidden" name="_wpcf7" value="1239">
    <input type="hidden" name="_wpcf7_version" value="5.5.6.1">
    <input type="hidden" name="_wpcf7_locale" value="en_US">
    <input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f1239-o3">
    <input type="hidden" name="_wpcf7_container_post" value="0">
    <input type="hidden" name="_wpcf7_posted_data_hash" value="">
  </div>
  <div class="row mb-4">
    <div class="col-md-6">
      <label>Doctor Name</label><br>
      <span class="wpcf7-form-control-wrap text-924"><input type="text" name="text-924" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
    <div class="col-md-6">
      <label>Clinic Name</label><br>
      <span class="wpcf7-form-control-wrap text-925"><input type="text" name="text-925" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
  </div>
  <div class="row mb-4">
    <div class="col-md-4">
      <label>DL No/Reg No:</label><br>
      <span class="wpcf7-form-control-wrap text-926"><input type="text" name="text-926" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false"></span>
    </div>
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WELLNESS IS WORTH WISHING

Toggle Navigation
 * HOME
 * ABOUT US
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Amica Life Science Pvt Ltd We are consistently Providing Healthier Lives for the
past decade We ensure the Delivery of reliable and safer product to market
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AMICA LIFE SCIENCE PVT LTD PVT LTD



We are privileged to place forward that we strived with a dedicated service to
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M.S. M.S.HOSPITAL CHENNAI
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Mcom accounts
DR INDRANAVANESAN
M.D.O.G(CANADA)
DR NAVANESAN
M.D.Cardio (Canada)
DR VENUGOPAL M.S
M.S. M.S.HOSPITAL CHENNAI
MR RAMASUBU
M.B.A.M.F.T H.R. India Admn. office.
MR SIVAKUMAR
Mcom accounts
DR INDRANAVANESAN
M.D.O.G(CANADA)
DR NAVANESAN
M.D.Cardio (Canada)
DR VENUGOPAL M.S
M.S. M.S.HOSPITAL CHENNAI
MR RAMASUBU
M.B.A.M.F.T H.R. India Admn. office.




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Order Form

Stockists Name

Executive Name

Booking Date

DL No:

GST No:

Phone Number

Choose Your Products:




AMETONE TAB

AMETONE Junior 200ML SYP

AMETONE 200ML SYP

AMEREST CC Tab

AMEREST CC 100ML SYP

AMEREST LS 100ML SYP

AMEQUEEN 200 TAB

AMEQUEEN OZ TAB

AMECLAV-625 Tab

DIOO GEL

AMECOBAL-OD




AMECOBAL 5G

AMECOBAL-INJ

AMEPAN-40

AMEPAN-DSR

AMEMOL-P

AMEMOL-SP

AMECET-LC

AMECET-AM

AMEZEE-250MG

AMEZEE-500MG


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Order form

Stockists Name

Booking Date

DL No:

GST No:

Phone Number

Choose Your Products:




AMETONE TAB

AMETONE Junior 200ML SYP

AMETONE 200ML SYP

AMEREST CC Tab

AMEREST CC 100ML SYP

AMEREST LS 100ML SYP

AMEQUEEN 200 TAB

AMEQUEEN OZ TAB

AMECLAV-625 Tab

DIOO GEL

AMECOBAL-OD




AMECOBAL-5G

AMECOBAL-INJ

AMEPAN-40

AMEPAN-DSR

AMEMOL-P

AMEMOL-SP

AMECET-LC

AMECET-AM

AMEZEE-250MG

AMEZEE-500MG


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Doctor Name

Clinic Name

DL No/Reg No:

GST No:

Clinic Contact No:

Choose Your Samples:
AMETONE TABAMETONE 200ML SYPAMETONE Junior 200ML SYPAMEREST CC TabAMEREST CC
100ML SYPAMEREST LS 100ML SYPAMEQUEEN 200 TABAMEQUEEN OZ TABAMECLAV-625 TabDIOO
GELAMECOBAL-OD
AMECOBAL-5GAMECOBAL-INJAMEPAN-40AMEPAN-DSRAMEMOL-PAMEMOL-SPAMECET-LCAMECET-AMAMEZEE-250MGAMEZEE-500MG

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