Bangalore Office

W-68, 4th Cross, Pipeline, Malleswaram,
Bengaluru, Karnataka 560003

Bangalore Contact details

Goa Office

Wildclickz Goa, #670, 1st floor
Fernadies bungalow, Opp Multipurpose School
Borda marg-goa, Goa – 400362

Goa Contact details

+918884449092

Sales & Support for Bangalore & Goa

info@wildclickz.com

Membership Registration

For Individuals, Register here. For companies email us at info@wildclickz.com

Your First Name (required)

Your Last Name

PROFESSION

MOBILE (required)

PERSONAL EMAIL (required)

HOME PHONE

COMPANY NAME

DATE OF BIRTH (required)

ANNIVERSARY DATE

ALTERNATE CONTACT NAME (required)

ALTERNATE PHONE (required)

FAMILY CONTACT NAME (required)

FAMILY PHONE (required)

FAMILY CONTACT RELATION (required)

PERSONAL WEBSITE

PRESENT CITY (required)

PRESENT PIN CODE (required)

PRESENT ADDRESS (required)

PERMANENT CITY (required)

PERMANENT PIN CODE (required)

PERMANENT ADDRESS (required)

DOCUMENTS- (ATTACH COPIES OF THE DOCUMENT AND ALSO CARRY ORIGINAL FOR VERIFICATION)

Primary Address Proof - DL / Passport (self-attested required, Max 1MB)

DL / Passport (required)

Secondory Proof - Aadhaar / Bank statement (self-attested required, Max 1MB)

Aadhaar / Bank statement No (required)

Upload Your Latest Photograph (required, Max 2MB)

I /We hereby declare that all the information provided by me above is true to the best of my knowledge and belief.

The documents and details furnished are valid and not expired. I undertake to promptly notify Wildclickz in the event of any change in the information contained herein above.

I am submitting this registration form to avail the equipment rental service and I agree and shall abide by the terms and conditions as per the Equipment Rental.