Indi Game

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Application Form

User Type * :

Agent Name* :

Retailer’s Name* :

Location* :

Establishment Address* :

PIN :

Tel. No* :

Mobile * :

Fax No :

E-mail* :

Landmark (1) :

Landmark (2) :

Area in* :

Sq.Ft. Owner Rented years

General Information

Name of Applicant* :

Residential Address* :

PIN :

Tel. No :

Mobile :

Fax No :

Near by Competitors Detail * :

IMPORTANT INSTRUCTIONS :

1. After receiving the Application from minimum 15 days will require for survey / installation.
2. Deposit of Playsment accepted through “D.D or Pay Order” in the name of Indigo Exim Pvt. Ltd.
3. Company have reserve right to reject application from.
4. Please do not give cash in deposit to any person.

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