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KAPTURE CRM

ADJETTER MEDIA NETWORK PRIVATE LIMITED


Registered Office- S.A.S. Veer Building, 3M-123/A, East of NGEF Layout, Kasturi Nagar, Bengaluru, Karnataka 560043, India

CHANNEL PARTNER REGISTRATION FORM

1. Name of Company :-_______________________________________________________________________


________________________________________________________________________

2. ADDRESS: ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

PIN CODE:_____________ STATE: __________________________ COUNTRY:____________

3. CONTACT DETAILS: ________________________________________________________________________

4. EMAIL/s:_________________________________________________________________________________

5. GST IN :__________________________________________________________________________________

6. FOUNDERS/DIRECTORS:____________________________________________________________________

7. INDUSTRY:_______________________________________________________________________________

8. YEAR OF INCORPORATION:_________________

9. MAJOR PRODUCT/SERVICES:________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

10. MAJOR CLIENTS : _________________________________________________________________________


________________________________________________________________________________________

11. REGIONS CATERED TO: ____________________________________________________________________

12. SALES TEAM(No.s) : _______________________________________________________________________

13. SERVICE TEAM(No.s):______________________________________________________________________

SALES TEAM SERVICE TEAM REVENUE CLIENTS


2019 2018 2019 2018 2018-19 2017-18 2018-19 2017-2018

NAME:____________________________________ TITLE: ___________________________________________

SIGNATURE:________________________________ DATE: ___________________________________________

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