REGISTRATION
FORM
(*All fields are mandatory)
|
| Buyer Type * |
|
Address |
| User Type * |
|
| Name of the Organisation/Person:*
|
|
| Contact Person* |
|
|
Date of Birth*
|
| |
|
|
|
| Designation* |
|
| Address/Street* |
|
| City* |
|
| PIN* |
|
| State* |
|
| Country* |
|
| E-Mail* |
|
| Phone* |
|
| Phone |
|
| Phone |
|
| Mobile |
|
| Fax |
|
| Preferred
User Id*( 8-12 characters) |
|
| Password*(
8-15 characters) |
|
| Confirm Password* |
|
| Sales Tax Reg. No./VAT No. |
|
| Passport No. |
|
| Voter's ID Card No. |
|
| PAN Card No. |
|
| GST No. |
|
| Payment in Favour of |
|
| |
Mailing Address |
Same As Above
|
| Street* |
|
| City* |
|
| PIN* |
|
| State* |
|
| Country* |
|
Second Representative Contact Address |
| Name of the Person |
|
| Date of Birth |
|
|
|
|
|
| Designation |
|
| Department |
|
| Street |
|
| City |
|
| PIN |
|
| State |
|
Country |
|
| E-Mail |
|
| Phone |
|
| Phone |
|
| Phone |
|
| Mobile |
|
| Fax |
|
| Banker Details |
|
|
| Bankers' Name* |
|
| Account Number* |
|
| Branch* |
|
Branch Code |
|
| Security Question |
|
| Question Answer |
|
| Comment |
|
| Buyer Terms & Conditions |
| Seller Terms & Conditions |
| |
|
|
I Agree
|
|