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New Customer Registration Form
Get new customers easily using this Customer Registration Form.
9
Questions
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1
Full Name
*
This field is required.
First Name
Last Name
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2
Phone Number
*
This field is required.
Please enter a valid phone number.
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3
Email
*
This field is required.
example@example.com
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4
What do you currently do?
*
This field is required.
Please Select
Business
Job
Student
Homemaker
Others
Please Select
Please Select
Business
Job
Student
Homemaker
Others
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5
If you are in business, what is the type of ownership?
*
This field is required.
Please Select
Proprietorship
LLP
Pvt Ltd Company
Pub Listed Company
Not in business
Please Select
Please Select
Proprietorship
LLP
Pvt Ltd Company
Pub Listed Company
Not in business
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6
If you are in a job, what is your position in the company?
*
This field is required.
Please Select
Board of Directors
Senior Mgmt
Mid Mgmt
Entry Level
Please Select
Please Select
Board of Directors
Senior Mgmt
Mid Mgmt
Entry Level
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7
How many years have you been in this business / Profession?
*
This field is required.
Please Select
20yrs plus
10 to 20yrs
5 to 10yrs
2 to 5yrs
Less than 2yrs
Please Select
Please Select
20yrs plus
10 to 20yrs
5 to 10yrs
2 to 5yrs
Less than 2yrs
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8
What challenges are you facing in your business?
*
This field is required.
Please Select
Ineffective Marketing
No Growth in Sales
Low Profit Margins
People Mgmt
Stagnancy Issues
Legal Battles
Procurement of Funds
Managing Cashflows
Please Select
Please Select
Ineffective Marketing
No Growth in Sales
Low Profit Margins
People Mgmt
Stagnancy Issues
Legal Battles
Procurement of Funds
Managing Cashflows
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9
What is your average monthly revenue in the last 12 months?
*
This field is required.
Please Select
5Crs and Above
2 to 5Crs
50Lacs to 2Crs
20Lacs to 50Lacs
Less than 20Lacs
Please Select
Please Select
5Crs and Above
2 to 5Crs
50Lacs to 2Crs
20Lacs to 50Lacs
Less than 20Lacs
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