Customer Application Form

Name*

Mobile Number*

Email*

Area*

Address*

Pincode*

Proof of identity*

PASSPORT

PAN CARD

AADHAR CARD

VOTER CARD

Connection Type*

HOME

OFFICE

GSTIN Number

Choose Plan* Select An Option HOME STARTER HOME LITE HOME SMART HOME PREMIUM HOME ULTRA HOME SUPER HOME MAX HOME ACE BUSINESS LITE BUSINESS SMART BUSINESS PREMIUM BUSINESS ULTRA LITE SMART PREMIUM ULTRA EPIC ELITE LUXURY GIGA BIZ PRO BIZ FLEX BIZ GRAND BIZ STARTUP NITRO LITE COMBO NITRO SMART COMBO NITRO PREMIUM COMBO NITRO ULTRA COMBO NITRO LITE FLEXI NITRO SMART FLEXI NITRO PREMIUM FLEXI NITRO ULTRA FLEXI NITRO LITE FLEXI COMBO NITRO SMART FLEXI COMBO NITRO PREMIUM FLEXI COMBO NITRO ULTRA FLEXI COMBO

Address Proof

Choose file

ID Proof

Choose file

Passport Photo

Choose file

Total Installation Amount Collected*

Device Serial Number*

CAF Filled by (team member name)*

Adhar Card Collected ?* Select An Option YES NO

Installation Payment Mode* Select An Option PayuMoney Online Axis POS MSwipe POS Cash Check

Hard copy CAF Collected ?* Select An Option YES NO

Submit Now