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REGISTRATION FORM FOR RECEIVING DEALER APPLICATION KIT:

* Compulsory Fields
* Name of the applicant :
* Company’s Name :
* Applicants Designation :
Applicants Addresss :
City     State
*Tel No.(include STD Code) :
(with city & country code)
*Mobile No. :
*Fax No. :
* E-mail:
Comments (if any):

PAYMENT DETAILS:
*Name of the Cardholder :

* Mailing Addresss :

*Credit Card No. :
*Type Credit Card :

*Expiry Date :

Month      Year

I hereby agree to pay Ace Indo Canada Rs.500/- towards charges for receiving dealer application kit by mail. I authorize Ace Indo Canada to charge my credit card Rs.500/- towards the same.




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