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ORDER FORM

REQUIRMENTS DETAIL ID proof


1 FIRST NAME Praveenkumar 1 Passport Size Photo Copy
2 LAST NAME R Company Pan card Photo Copy
3 EMAIL ID ranjith.g@haqto.com Voter id card Photo Copy
4 MOBILE NUMBER `+919994344182 Aadhar card Photo Copy
5 COMPANY NAME Bliss Globe Solution (OPC) Pvt.ltd

6 ADDRESS 10/28, Rajaji Road, Ramnagar.

7 STATE Tamil Nadu


8 CITY Coimbatore
9 PIN CODE 641009
10 WEBSITE NAME bcoin.one
11 IP ADDRESS 03.235.105.199
12 AMOUNT (SETUP FREE) 29,500
13 BANK NAME HDFC Bank
BANK ACCOUNT
14 `50200088242908
NUMBER
PAYMENT TRANSACTION
15 `331807327069
ID
16 PAN NUMBER AAMCB0090J
17 AVG DAILY RECHARGE upto 1lac
18 GST NUMBER Nill
19 Aadhaar Card Number `902518769444

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