Dutch Dutch
 
 Spare Parts Order
 
 

(Please fill this order form and forward to us. If you prefer to fax number is 0094 -11- 4628330.For fast personal assistance contact – Prasanna - 0094 -777 – 285623.)

Your Name: A value is required.
Phone Number:
(During Business Hours)
A value is required.
Mobile Number:
Fax Number:
(Include Area Code)
E-mail Address: A value is required.Invalid format.
Preferred Method
of Contact:
Please select a valid item.
Company Name
Address: A value is required.
Country: A value is required.
Model
Axle
Suspension
   
Part Details:
(Please Enter in Part Number, Description, and Quantity Required.
Refer to Parts Catalogue)
 Part Number
Description
Quantity Required
   
Billing Address
Shipping Address
   
Method of payment
Cash Bank Transfer Cheque
 
Card name
Exp: Date
Name on Card
Other Method
   
   
 
 
 
Dutch Dutch
 
Address: 32, Wijerama Road, Gonawala, Kelaniya, Sri Lanka.
Tel: +94-11-2914206, +94-11-2914505; +94-11-2914539, +94-11-4408365/6 Fax +94-11-4408763
E mail : dlt@dlt.lk, dltmd@dlt.lk

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