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Euro Pay Inc: Application No

This document is a registration form for Euro Pay Inc. It requests personal information such as name, address, contact details, as well as payment and referral details. Applicants must agree to the company's terms and conditions. The form collects essential registration information for a payment processing service.

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vinothsj
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145 views1 page

Euro Pay Inc: Application No

This document is a registration form for Euro Pay Inc. It requests personal information such as name, address, contact details, as well as payment and referral details. Applicants must agree to the company's terms and conditions. The form collects essential registration information for a payment processing service.

Uploaded by

vinothsj
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

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EURO PAY INC


Registration Form

Application No:

Personal Information Details: Euro I.D Date:

First Name Middle Name Last Name

Sex: Male Female Marital Status: Single Married

Date of Birth: Edu.Qualification:

Your Present Address:

City:

State: Pin: rw

Telephone: Mobile: 91
E-Mail:

Payout Details

Payout Option: E-Transfer: Pay Direct card:

A/c Name A/c No

Bank Name & Address

Bank IFSC CODE

Payment & Referral Details IN -

Referred By: Euro I.D Name

Accommodate By: Euro I.D Name

Received:
Cheque (or) D.D(or) NetTransfer Bank Name

I agree to the term&conditions, which have been clearly explained and accepted to me.
For Terms&conditions Refer Company Website. Applicant’s Signature & Date

Euro Pay Associates – Chinnasamy Gownder Building 1st Floor, 1b Arokiyasamy Street,
N.S.R Road Saibaba Colony, Coimbatore – 641038. TamilNadu, India.
E-mail: [email protected], [email protected] URL: www.europayinc.com www.europayassociates.com
Ph: 0422 – 646EURO (6463876), Customer Care: 91 9976345345 Customer Support: 91 98434 50555

For Office Use: _ _ _ _ _ __ _ __ _ __ _ __ _ __ _ __ _ __ _ __ _ __ _ __ _ __ _ __ _ __ _ _

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