REGISTRATION
FORM
(*All fields
are mandatory) |
| Seller 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. |
|
| 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 |
|
| Comment
|
|
| Buyer Terms & Conditions
|
| Seller Terms & Conditions
|
| |
|
|
I Agree
|
|