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Advance Deposit
OP No
Name
Mobile No
Name
(*)
Gender
(*)
Male
Female
Mobile No
Email ID
OutPatient Advance
InPatient Advance
IP NO
Amount
(*)
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qualification details
Payment
Parameter Name:
Parameter Value:
Compulsory information
TID :
Merchant Id
Order Id
Amount
Currency
Redirect URL
Cancel URL
Billing information(optional):
Billing Name
Billing Address:
Billing City:
Billing State:
Billing Zip:
Billing Country:
Billing Tel:
Billing Email:
Shipping information(optional):
Shipping Name
Shipping Address:
shipping City:
shipping State:
shipping Zip:
shipping Country:
Shipping Tel:
Merchant Param1
Merchant Param2
Merchant Param3
Merchant Param4
Merchant Param5
Promo Code
Customer Id:
