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Customer Information Form
ID Type
Commercial Registration (CR)
Unified Number
Tax Indentification Number
GCC ID
Sagia License
Not Available
Required
ID Number
Required
Company Name (English)
Required
Compnay Name (Arabic)
Required
VAT Number
Required
VAT number must be 15 digits, starting and ending with 3.
CCI Number
Branch Name
Select
Riyadh Branch
Jeddah Branch
Dammam Branch
Required
Salesman Name
Select
Hussain Ali H Aldarwish
Ahmad Faisal M Soleja
Sayeed Mohamed Jawad
Syed Fahim
Abdul Hamid Mohamad Amin
Tanweer Ahmed Shah
Mohammad Ahsan Farooqui
Talat Najah Ganimah Abdul Hadi
Nizam Uddin Chowdhury
Abdulrahman Faisal Mahyoub Ghaleb
Ismail Najah Ganimah Abdul Hadi
Mohammed Rafi Shaik
Ibrahim Islam Khan
Rehan Basit Basit Yar
Mainuddin Habibullah
Saif Alam Abbasi
Mohammad Arif Farooqui
Mohd Rashid Farooqui
Shamshul Islam Ahmad Siddiqui
Mohammad Rashid Alimuddin
Required
Address Details
Short Address
Short address must be 8 characters
Building Number
Required
Building number must be 4 numbers
Additional Number
Required
Additional number must be 4 numbers
Unit Number
Street (English)
Required
Street (Arabic)
Required
District (English)
Required
District (Arabic)
Required
City (English)
Required
City (Arabic)
Required
Region (English)
Required
Region (Arabic)
Required
Country (English)
United Arab Emirates
Bangladesh
Bahrain
Egypt
India
Oman
Pakistan
Qatar
Saudi Arabia
Turkey
Required
Country (Arabic)
الإمارات العربية المتحدة
بنغلاديش
البحرين
مصر
الهند
سلطنة عُمان
باكستان
دولة قطر
المملكة العربية السعودية
تركيا
Required
Postal Code
Required
Postal code must be 5 numbers
P.O. Box
Contact Details
Name
Required
Designation
Required
Mobile Number
Required
The mobile number must start with zero and be exactly 10 digits.
Email
Please enter a valid email address.
The mobile number must start with zero and be exactly 10 digits.
Please enter a valid email address.
The mobile number must start with zero and be exactly 10 digits.
Please enter a valid email address.
Credit Details
Requested Credit Amount
Required
Requested Credit Period (Days)
Required
Documents
C.R. Certificate
Required
Only .pdf files are allowed
VAT Certificate
Required
Only .pdf files are allowed
National Address Certificate
Required
Only .pdf files are allowed
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