Dealer/SI Registration Form

  Company Name and Address *: Residential Address :
  Office Phone Number* : Residence Phone Number :
  Mail Id *:    
  TIN Number *:    
  Company Type * :
Pvt Ltd
  Directors Name and
Contact Details :
Name Mobile Mail id
  Other Department
Contact Details :
Name Mobile Mail id
  Trade Reference :
1 Ingram Micro   Others Specify
2 Rashi Peripherals  
3 Redington  
4 Compuage Infocom  
  Terms and Conditions :
1 Terms and mode of Payment shall as may be agreed upon between eCAPS and Dealer from time to time.
2 The dealer should sign and seal a copy of the invoice on receipt of material. For Materials sent through courier/Transport if there is any difference in materials should be informed within two days from the date of receipt.
3 The dealer should honour the cheque on the date. If any cheque is dishonoured eCAPS will charge Rs 250/- as bouncing charge and 24% annual interest till the payment received.
4 Disputes which cannot be settled amicably will be governed by the laws of India and the parties hereby submit to the exclusive Jurisdiction of Coimbatore Courts
  Please Provide following details with the form :
TIN Certificate Copy Photo
Residence Proof copy  
  Statement :
I Hereby certify that the information I have provided in this form is correct to the best of my knowledge and belief.