[text* name placeholder “Enter Your Name”]

[email* email placeholder “Enter Your Email”]

[tel* tel placeholder “Enter Your Phone No.”]

[text* estb placeholder “Enter Name of Establishment”]

Status of Establishment [select* estab “Proprietorship” “Partnership” “Pvt. Ltd. ” “Individual”]

Status of Applicant [select* status “Proprietor” “Partner” “Chairman” “CEO” “MD”]

[textarea addre id:addre placeholder “Enter Your Address”]

[text partnership placeholder “If Partnership concern name of the partners”]

Date of commencement of Business[date* date placeholder “Date of commencement of Business”]

Type of Business [checkbox* business use_label_element “Showroom” “Wholesaler” “Retailer” “Consumer” “Other”]

[text turnover placeholder “Annual Turnover (If applicable)”]

[text products placeholder “Interested Products.”]

[submit “Send”]