Distributor Registration Form
*Your Country  
*Company Name  
Type of Company     Others
Your company’s registered address  
*Postal / Zip / Pin Code  
*Office Telephone Number   - -
Country Code - Area Code - Number
Your extension Number  
Office Fax Number   - -
Country Code - Area Code - Number
*Your Company Website   http://www.
Nature of your current business  

Others: Please Specify:
Products / services Currently handled  
Which are the brands your company deals in  
Average annual turnover of your company  
Please specify the currency eg: INR, USD, RM etc.
Which are the market regions you are currently active in ?  
Number of employees in your company  
*Your Full Name  
*Designation in the company  
Your direct contact number   - -
Country Code - Area Code - Number
*Mobile Number   -
Country Code - Number
*Your Email ID  
How did you know about “Clik-a-site”?  
How many websites do you feel you can sell every month, in your region ?  
Number of sales people you are willing to dedicate to promote “Clik-a-site”?  
Are you looking for advertisement support ?   Yes No
If yes, are you willing to share the advertisement cost with us ?   Yes No
Which payment mode do you prefer   Cash  Cheque / DD  Credit Card
Telegraphic Transfer / Bank Transfer
 Remarks, if any  
Term & Conditions:

I have read the above terms & conditions & agree to the same.
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