MEMBER REGISTRATION FORM

 
 Company
Items marked with a red star are mandatory 

Company Name *

Company Type *

Company Turnover *
US$ per annum
No. of Company Employees *

Address *

Country
*

State
*
If outside India, please specify the State
City *
If outside India, please specify the City
Zipcode *

Email address *

Phone 1 *
+
( )
Phone 2
+
( )
Fax
+
( )
Website URL

How did you hear about us ?

Please give us the details of the Company, who has recommended ebizchem to you.
Company's Name

Company's
ebizchem ID


 Credibility Information
Items marked with a red star are mandatory 

Certification eg. ISO, etc.

Bank reference, give email address, if applicable*

Trade Reference, Association Name and its email address

Parent Company

Parent Company Email

Parent Company Website

 

 Member Name and Password
Items marked with a red star are mandatory 
For your protection, a company/location Member Name AND Password is required to securely carry out your transaction like offers or inquiries and to negotiate and conclude deals on ebizchem. Please save it in a secure place.
Member Name *
Please enter a member name of length 5-8 characters
ebizchem ID *
Your ebizchem ID will be the prefix to your ebizchem email address viz. Mark in ebizchem ID will create [email protected] and will be identifying your Company with this ID everywhere.
Password *


Please choose a passowrd of length 5-8 characters

Re-enter Password *

 
 Authorised Person
Items marked with a red star are mandatory 

A primary contact, or company administrator, for your company/location is required. This person must be authorized to perform purchases or sales on behalf of your company/location. He/she will also be the main contact and will receive all the correspondences if your company/location sells chemical products. He/she will be responsible for administration of your company/location account. Please contact ebizchem Client Services if correspondence should be sent to someone other than the primary contact you indicate below.

Title *

Name *

Designation *

 

 Terms and Conditions

I Agree to Terms and conditions


FREE Registration upto 30th September, 2000


Next step is product registration. If you wish, you can skip directly to the review step, and register the products at a later date from within MyOffice.

Skip Product Registration Step


 
 
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