CRM Registration Form
Personal Details (Management Form)
First Name
Last Name
Designation
Mobile
*
Email iD
*
Admin Details
First Name
Last Name
Designation
Mobile
*
Email iD
*
Accountant Details
Name
*
Mobile
*
Email iD
*
Firm Details
Firm Name
*
Email ID
*
Address
Mobile
*
Land Line
City
State
Select
Andaman & nicobar islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Daman & diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & kashmir
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Employee Strength
Website URL
Login Details
Sub Domain Name
*
Service Category
Select
100% Online
100% Offline
Online Offline Synchronization
Online Application and Offline Database
Payment Type
Select
On Rent
One Time
On Rent and One Time
Payment Mode
Select
Monthly
Quaterly
Half Yearly
Yearly
No. of User
Registration Date
Activation Date
Payment Details
Cheque No
Cheque Date
Cheque Amt
Implemented Amt
Setup Fees
Product Cost
Total Tax
(Tax percent is 15%)
Executive / Vendor Details
Note: Please Fill At Least One Field From Vendor Code And Vendor Mobile
Vendor Code
Vendor Mobile
Note: Please insert this No. 9009672400 in vendor Mobile field for Demo.
Other Services
Services
1.
Bulk SMS
Quantity
2.
IVRS
Quantity
3.
Voice SMS
Quantity
4.
Website
Quantity
If you want Website Service please fill below fields otherwise ignore this.
Domain
Page
Type
Static
Dynamic
Emails
Yes
No