Company Details and General Information Name Of Company Address Pincode City/ State/ Country E-Mail Address Website Address Name & Title Of Company Representative Gst Certificate/ Tin Number/ Pan Number Telephone Number Of Company Representative Direct Number Mobile Number Date Company Was Established Gross Annual Sales For The Last Three Years Year Gross Year Gross Year Gross Legal Structure (Check One) Corporation Partnership Sole Proprietorship Joint Venture Franchise Non – Profit Type Of Business / Commodity Service (Check One) Retailer Publication / Broadcaster Manufacturer Wholesaler Construction Contractor Professional Services Consultant Other Distribution / Dealer Service Provider Freight / Transportation Details On services Or Goods Your Company Supplies Geographic Services Area (Check One) Local Regional National International Have You Previously Done Business With The Choza D2H Organization Yes No Have You Previously Done Business With Other International Organizations? Yes No Banking Information Bank Name Bank Address Bank Account Number Beneficiary Name IFSC MICR Account Type Profit Price % Signature I, the undersigned, hereby accept the CHOZHAD2H General Terms & Conditions, a copy of which has been provided to me, and warrant that the information provided in this form is correct and, in the event of changes, details will be provided as soon as possible. Name Title Signature Date SUBMIT