Reseller
Order Form
Note : Fields marked with * are compulsory
* Name * Role
in Company
[Select one]
Top Management
Middle Management
Business Executive
Others
Please let us have
your Name and your Role in your Company.
*
Name of Company Please let us have
the Name of your Company.
Ownership India-based Foreign-based
*
Telephone Please select the
Ownership Status and provide us wth your Telephone No.
* Address
Please furnish
us with your Correspondence Address.
Please let us know
the Country/State you are from.
Fax *
Email Please also provide
us with your Fax No. and Email Address.
Nature of
Business
[Select one]
CyberCafe
Web Hosting Firm
Software Developer
Student
Consultancy
Others
Type of Industry
[Select one]
Education
Electronics,Industrial
Machinery
F&B
Medical &
Pharmaceutical
Professional Services
Infocomm Technology
Real
Estate,Infrastructure,Engineering
Shipping & Logistics
Tourism & Hospitality
Trading & Distribution
Others
What is the Nature
of your Business and Type of Industry?
Year Incorporated
* Choose the
Platform of Hosting : Linux Platform Windows 2003 Platform Linux or Windows
Hosting ?
*
Mention the Package name / Webspace :
Choose your preferred
pack
*
Mode of Payment :
Demand Draft Cash Funds Transfer through ICICI/
Global Trust Bank Funds Transfer thro' Western
Union Other
Choose your Payment
Mode
*
Your Queries if any Any of your queries
/ suggestions/ comments
Referrer
: (How you gotto know aalpha NET)
You are Here > 
