Franchisee Registration Form

First Name *

Middle Name

Last Name*

Date Of Birth *(dd/mm/yyyy)

Mobile Number*

Email Id*

Address 1*

Address 2

State*

City*

Pincode

Bank Name

PAN No

Account Number

IFSC CODE

Occupation *

Education Qualification *

Which Industry/Sector you have prior experience?*

Where will you operate your business from?*

Where is your currrent business location(shop/office)? *

Where does the customer interaction happen in your current business format*

Who will support you in this new business?*

What is your total experience in business?*

How much time are you willing to devote for this new business everyday?*

Are you associated with any of the following? *

Franchisee experience with*

Username*

Set Password*

Confirm Password*

Introducer ID*

Area

in sq feet

I hereby declare that the details given herein are true, correct and complete to the best of my knowledge and belief, the photo copy of the documents submitted at a later stage are genuine and belong me. I hear by undertake to promptly inform Biztechnologies PVT. LTD in writing, of any changes in the information provided herein above and agree and accept that REKOMART is not liable or responsible for any losses, costs, damages arising out of any actions undertaken or activities performed by REKOMART on the basis of the information provided by me as also due to my not intimating / delay in intimating such changes. I hereby authorize REKOMART to disclose, share, remit in any form, mode or manner, all / any of the information provided by me. I hereby agree to provide any additional information / documentation that may be required by REKOMART, in connection with this application. I also agree that REKOMART has the right to reject my application form on any ground without any reason.