Indent Form - How to use?

This is for the use of Medical Practitioners, Doctors,
Hospitals, Institutional buyers, Laboratories
Who are desirous to buy Homeopathic Medicines
in bulk and/or according to their customize specifications!

• Kindly fill-in the form with all the details
  as given in the first box as an example.
  Please clearly specify the Medicine name, Potency,
  Quantity, Form, Number of Unites required etc.

• On receipt of this we will get back to you with
  an "Acceptance Note" and a "Statement of Availability"
  with prices etc. Only when you like the prices and other terms,
  you can confirm the order by paying the bill.

• Very simple! Kindly fill the form and Submit it
  we will get back to you very soon.

• Thank you! Our usual terms of business shall apply
  and payments through CCNOW (Secure Payments)