We are confirming our interest in availing of the Global Biomatrix products as indicated below:

First Name:
Last Name:
Address:
PIN CODE:
CITY / TOWN:
STATE:
PHONE MOBILE
LAND LINE:
EMAIL:
GST N0
PAN NO
Approximate - Total treatment area   Sq.ft
OFFICE:   Sq.ft; FACTORY:   Sq.ft; Apartments:
We wish to employ you for treatment Yes /No:
Yes No
I wish to buy the Smart Assure Surface protection:   litres .

1 litre can treat approximately 2000 to 2500 sq.ft – and provide protection for upto 30days.

I wish to buy Smart Assure Sanitizer:   ML.   BOTTLES
I wish to buy Smart Assure Detergent   litres. Fabric protection for weeks

We hereby confirm that we will follow the instructions on the label about how to use the products .

Please contact the undersigned to discuss the delivery and payment schedule.

Please contact the undersigned to discuss the delivery and payment schedule.

For




SIGNED IN CONFIRMATION




INDIVIDUAL

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