Customer Relationship Form Toll Free No. 1800-419-4400 To be filled in block letters. Please use a ballpoint pen while filling the form. eQuartis ABSPL.: Regd.office: Sco 60-61 Top Floor, Sector 17 A, Chandigarh-160017, India. Visit at www.equartis.in Serial No Unique Code Information To Activate Your Services (as given in the Proof of Identity document attached with application) 1. Organisation Name AFFIX PHOTO of SIGNATORY Kindly paste your Latest passport size photo. Kindly ensure your signature overlaps on photo as well as the form. Name of authorised Signatory Designation Department Mobile No. Email Date of Birth D D Anniversary Y Y Y Y M M D D Y Y Y Y M M Photo ID Proof type of authorized signatory Document No. Date of Issue Place of Issue Issuing Authority 2. Billing Address: Building No./Plot No. Street Address/Village City/District Locality/Tehsil State/UT Pin 3. Registered Office Address: Building No./Plot No. Street Address/Village City/District Locality/Tehsil State/UT Website Pin Facebook Web Address 4. Spoc Details Payment Monitoring Contact Person's Name Contact Person's Name Designation Designation Mobile No. Dept. Name Dept. Name Email Email Mobile No. Additional information to serve your organisation better 5. Your Organization is Proprietorship Partnership Pvt. Ltd. Public Corp. 6. Customer Service Region North South East West 7. No. of Employees 1-10 10-50 50-100 100-500 Govt. Others >500 if >500, Specify No. 8. Your Industry Type 9. Your Turnover is in (Rs. Millions) >-5000 1000-5000 10. Your Annual Customer Service spend (Rs. Lacs) <10 100-1000 20-100 <=20 10-20 20-50 50-100 If >100, specify value 12. Package Enrolled: Toll Free Non Toll Free Bill Plan QRT-15 QRT-30 QRT-60 Duration D D Monthly commitment : (INR) QRT-Classic Additional Package (if any) Duration D D Start Date D D M M 13. Payment Details: QRT-10 M M QRT-Prime QRT-25 QRT-50 Start Date M M D D M M Y Y Y Y QRT-Super Y Y Y Y Advance Rental (INR) Security Deposit (INR) One Time Regn /Activ. Fee (INR) Cheque No. Date Bank/Branch Your Organisation Specific Requirements 14. Additonal requirements Customised IVR Web-Chat SMS & Email Integration Regional Language Support Click-to-call Social Media Integration Call-Conference Voice Mail Service Custom On-hold Music Advanced Call-forwarding Mini CRM Customization Declaration By Customer I/We have read and understood the terms and conditions mentioned overleaf and unconditionally accept them as binding on me/us. I/We understood all the rates, tariffs and other related conditions on which services will be provided Nationally, as applicable on this date and as amended from time to time. The details on CRF have been filled in by me/us and are true and correct in all respects. I/We also undertake to pay all the charges raised on account of services availed. In order to ensure compliance with the Government of India Regultation, I /We confirm the genuineness of the documents submitted by me/us with this CRF. Name of the Customer Signature of the Customer (with Co. Seal & Stamp) Date Location For Office Use Only Sales Reference No. Mobile No. BD Name Agent /Partner Code Channel Partner Stamp *Terms & conditions apply Order & Payment Details