Customer Registration Forms
*
Indicates Required Fields
Basic details
Account_ID/Email_ID
*
:
Firm Name
*
:
Contact Person Name
*
:
Role
*
:
Select Role Type
Retailer
Distributor
Registration Date
:
3/28/2024
Projects Name
*
:
Account Status
:
Active
IS Multi Site/Branch ?
:
Yes
No
ADDRESS DETAILS
Address
*
:
Address1
:
Address2
:
Country
*
:
Select Country
India
State
*
:
Select State
City
*
:
Pin code
*
:
LandLine No1
:
LandLine No2
:
Mobile No1
*
:
Mobile No2
:
PRODUCT DETAILS
Product Name
*
:
Product Serial No
*
:
Product Edition
:
Activation Date
: