Ektra Brand Ambassador Registration Form

Sponsor ID & Name*

Name of the Company/Customer*

Name of the Director/Owner

Registered Office Address with PIN Code

Full Billing address with PIN Code

Shipping Address

Land mark if any

Telephone No. / Mobile No.

Email ID

Bank Name
Account No.
Address

IFSC Code

Swift code, If any

Intermediate Bank, if any

IEC Code, if any

PAN No. (Attach Copy)
GSTIN No. (Attach Copy)

Aadhar No.(Attach Copy)

Date of Birth

Anniversary Date