New Application Form
Personal Details
*Select Store Type:
*First Name:
*Last Name:
*Date of Birth:  
Postal Address:
District / City:
State Name:
Pin Code:
Country Name:
*Mobile Number:
*Mobile Verification Code:
*E-Mail Address:
*E-Mail Verification Code:
* Address Proof :
Upload Scan copy of document:
You can upload good quality product image in JPG or PNG format.
Bank Details
*Account Number:
*Bank Name:
Branch Name:
Membership Details
*My Store ID :  
*My Store Name:
*Sponsor Store ID:  
  I agree terms and conditions, General Customers Terms, My Store Terms, My Premium Store Terms,
Submit and Print
  Note: Sent copy of this form along with documents to company address though courier or post.