Customer Name*

Customer Mail ID*

Customer Contact No. for Backend to Call*

Customer Contact No.*

Alternate Contact No.

Business Name*

Address Line 1*

Address Line 2*

Address Line 3

Current Location*

City*

State*

Pin Code*

Page Status
New Page
Existing

Google Page Link*

Google 360 VT
Basic
Premium

Google 360 VT(SFT)
0-500
500-1000
1000-1500
1500-2000
2000-2500
2500-3000
3000-3500
3500-4000
4000-4500
4500-5000
Other

If other

Comment*

Photography Instructions

Total Package Amount*

Taxation
Yes
No

Invoice Name

GST No.

PAN No.

Invoice Address

Mode of Payment
Cheque
Online

Cheque Name

Cheque No.

Bank Name

Cheque Date
On Date
PDC
NA

Online Transaction ID
Registration Date*
Upload Selfie*

Cheque Leaf or Online Transaction Screenshot*

Area Name*
BA Name*
BA Email*
BA Code*
BA Pan No.*
Comments