Please send us a cheque/DD (payable at Mumbai) for Rs 330* (Rs Three Hundred Thirty) in favour of Quantum Information Services Private Limited.
Please print or make a copy of the form below and include it along with your cheque/DD.

Name (in full) : ________________________________________

(First Name) (Middle Name) (Last Name)

Address : ________________________________________

City : _______________ Pin Code : _____________

E-mail ID : ________________________________________

Amount : Rs 330* (Rs Three Hundred Thirty)

Bank Name : ________________________________________

Cheque/DD No. : ________________________________________

Your Username : ________________________________________

Please fill in your Username exactly as you enter it on www.equitymaster.com

* Inclusive of 12.36% service tax payable to Government of India.

Please send the cheque/DD and the required information to:
Attention: Gurpreet
Quantum Information Services Private Limited
15, Khetan Bhavan 3rd Floor, 198, Jamshedji Tata Road, Churchgate, Mumbai - 400020, India.

Name (in full)	:	________________________________________
		(First Name)	(Middle Name)		(Last Name)
Address	:	________________________________________
City	:	_______________	Pin Code	:	_____________
E-mail ID	:	________________________________________
Amount	:	Rs 330* (Rs Three Hundred Thirty)
Bank Name	:	________________________________________
Cheque/DD No.	:	________________________________________
Your Username	:	________________________________________
Please fill in your Username exactly as you enter it on www.equitymaster.com