Customer Registration Form

Customer Name (as per PAN/GSTIN)

Address (Billing Address)

Address Line 1

Address Line 2

City

State

Zip Code

Country

Point of Contact – Details

First Name

Last Name

Email ID

Phone/Mobile

Alternate Email ID

Alternate Phone/Mobile

Organization Details

Bank Details

Hard / Soft copy of Bank Cancelled Cheque or Bank Declaration Letter with SEAL to be uploaded

Bank Name

Bank Account Number

Re-Enter Account Number

Account Holder Name

Bank Branch & City

IFSC Code

Cancelled Cheque or Bank Declaration Letter with SEAL

Choose File

Statutory Details

Provide a copy of certificate for the given statutory details

PAN Number

Is the company/firm registered under GST?

Yes

Are you a composite dealer under GST?

Yes

GSTIN – Goods and Services Tax Identification Number

Company Status

Certificate of Registration (Company / Other)

Choose File

PAN Copy

Choose File

GST Registration Certificate

Choose File

Any Other Documents

Choose File

I declare that the information furnished above is correct to the best of my knowledge, I undertake to inform the company immediately for any changes in the details mentioned above.