REGISTRATION FORM -Non Residential
Fields marked with asterisk (
*
) are mandatory to fill in
Consumer Category
*
Select Category
Commercial
Government
Industrial
Institution
Social Sector
Consumer SubCategory
*
Select SubCategory
Name
*
Discom Name
*
Email
*
Mobile
*
FAX Number
Website
(if any)
Primary Contact Person
Name
*
Designation
*
Mobile Number
*
Phone Number
Alternate Contact Person
Name
Designation
Mobile Number
Phone Number
Password
*
[Password should atleast contain 1 upper case, 1 lower case, 1 number, 1 special character and minimum 8 character]
Confirm Password
*
Captcha
*
reset
Submit