சிரித்திரனை விநியோகம் செய்ய

CONTACT DETAILS


COUNTRY:
SHOP NAME :
TELEPHONE :
FAX :
PERSON OF CONTACT NAME & TITLE :
CONTACT PHONE 1 :
ADDRESS :
WEBSITE :
EMAIL :
CONTACT PHONE 2 :

SHOP DETAILS


GENERAL DETAILS OF SERVICES GOODS :
NUMBER OF MAGAZINES REQUIRED :
SERVICE AREA :
BUSINESS TYPE :
ADDITIONAL INFO :
EXPECTING MONTHLY SALES OF MAGAZINES :
LEGAL STRUCTURE :
REGISTRATION NUMBER :
BUS ROUTE :

BANKING INFORMATION


BANK NAME :
BENEFICIARY NAME :
ACCOUNT NUMBER :
BANK ADDRESS :

CERTIFICATION

I hereby affirm that all information supplied is true and accurate to the best of my knowledge and belief, and I understand that this information will be considered for the transaction of magazines monthly. And I swear that I will send the sale amount monthly without any delay.

PRINTED / TYPED NAME
SIGNATURE
Image of registration document Or Image of NIC
TITLE
DATE