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| *Your Country |
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| *Company Name |
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| Type of Company |
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Others
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| Your company’s registered address |
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| *Postal / Zip / Pin Code |
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| *Office Telephone Number |
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Country Code - Area Code - Number |
| Your extension Number |
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| Office Fax Number |
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Country Code - Area Code - Number |
| *Your Company Website |
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http://www.
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| Nature of your current business |
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Others: Please Specify:
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| Products / services Currently handled |
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| Which are the brands your company deals in |
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| Average annual turnover of your company |
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Please specify the currency eg: INR, USD, RM etc. |
| Which are the market regions you are currently active in ? |
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| Number of employees in your company |
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| *Your Full Name |
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| *Designation in the company |
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| Your direct contact number |
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Country Code - Area Code - Number |
| *Mobile Number |
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Country Code - Number |
| *Your Email ID |
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| How did you know about “Clik-a-site”? |
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| How many websites do you feel you can sell every month, in your region ? |
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| Number of sales people you are willing to dedicate to promote “Clik-a-site”? |
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| Are you looking for advertisement support ? |
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Yes No |
| If yes, are you willing to share the advertisement cost with us ? |
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Yes No |
| Which payment mode do you prefer |
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Cash
Cheque / DD
Credit Card
Telegraphic Transfer / Bank Transfer |
| Remarks, if any |
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Term & Conditions:
I have read the above terms & conditions & agree to the same. |
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