Infibeam.com - Merchant / Vendor Sign Up Form

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Merchant Sign-up Form
**All Fields marked with * are mandatory.**

Merchant Name*
Address*
City*
Country*		Other Country
Pincode*
Merchant Signing Authority
Name*
Designation*
Effective Date*	Please enter Effective Date
Individual/Company PAN*	This field is required Please Enter a valid PAN
Product Category*		Other
Estimated Commission Margin(%)*
Product Listing Fee
Product Description*
Fulfilment to the Customers by*	Infibeam Merchant
Merchant Point of Contact
Name*
Designation*
Email*
Landline	Landline number must be of 11 digits
Mobile	Please provide either your Mobile Number or Landline number Mobile number must be of 10 digits
Comments if any
	Type the characters you see in the picture


	I agree with Merchant Signup Terms & Conditions

	On registration under this Merchant Agreement, an Infibeam representative shall get in touch with you for negotiation of the Commercial terms. Once you agree on the commercial terms we will send you our standard form which needs to be sign and seal on company’s letter and signed by its Authorised signatory