• Customer Data Sheet

To be filled and submitted by customer for initial registration to generate the code.

Please provide the accurate information with exact spellings to avoid delays and mistakes in reporting.

Name of the company* :
Date :
Office Address* :
Office Tel. No.* :
Office Cell No. :
Contacts for office communications*
Type of email Name of the person e-mail ID Contact Number
For accounts/payments
For reports
Authorized signatory* :
Designation :
email ID* :
Type of company :
PAN Number* :
Associate Company
(If Any)
:
Type of company :
Name of the site * :
Site Address* :
Site tel. Number* :
Site Contact Person* :
Contact number* :
Company Website :
For viewing the test reports on our website, we are providing the login and password.
Authorized person to get*
Durocrete login & password
:
email ID* :
(by giving this authorization you abslolve Durocrete from the responsibility of misuse of the facility by authorized person.)
Contacts for site communications*
Type of email Name of the person e-mail ID Contact Number
Director / Proprietor
For accounts/payments
For reports
Note: fields marked * are compulsary to generate the code number.
( Please provide the accurate information with exact spellings to avoid delays and mistakes in reporting.)