Suppliers Registration Form

Name of Firm / Company *	:
Category	:
If, Other	:
Nature of Business	:
If, Other	:
Name of Proprietor / Partner / Director	:



Office Detail
Contact Person *	:
Address *	:
Country	:
State	:
City	:
Zip	:
Phone No. *	:
Fax No.	:
Mobile No.	:
Email	:
Website	:



Factory Detail
Contact Person	:
Address	:
Country	:
State	:
City	:
Zip	:
Phone No.
Fax No.	:
Mobile No.	:
Email	:
Website	:



GST / VAT No. & Date	:
CST No. & Date	:
PAN No.	:
Service Tax No.	:

Excise Reg. No. & Date	:
Commissionrate	:
Range	:
Division	:

Ref. By	:
Message	: