1st floor, 7th Heaven Complex, G.S.

Road,
Ulubari, Guwahati-7

DEALER REGISTRATION FORM

2013-2014

Name of the Organization

: ____________________________________________________

Address

: ____________________________________________________
____________________________________________________
____________________________________________________

Phone No (Off. & Res.)

: ____________________________________________________

Mobile No.

: ____________________________________________________

Fax Number

: ____________________________________________________

Email ID

: ____________________________________________________

Name of the Proprietor/Partners: ___________________________________________________

Qualification

: ____________________________________________________

Your Birthday

: ____________________________________________________

Your Spouse Birthday

: ____________________________________________________

Your Marriage Anniversary

: ____________________________________________________

Your preferred courier name

: ____________________________________________________

TIN No.

: ____________________________________________________

Deals in

: Hardware / Software / Maintenance/Accessories

Customer Type

: End users / Corporate