Customer Data Form

Customer Name*
Customer Address
House No
Municipality
Panchayat
District
State
Pin Code
Email ID
Gender
Male
Female
ProductS
Owned
Wish to Purchase in one Year
LED TV
Air Conditioner
Refrigerator
Washing Machine
Air Cooler
Chimney
HOB
Cooker
Electric Iron
Fan
Grinder
Home Theatre
Induction Cooker
Invertor
Juicer
LPG Stove
Microwave Oven
Mixi
Stabilizer
Vaccum Cleaner
Water Cooler
Water Heater
Water Purifier
Mobile Phone
Laptop
Destop
Customer Invoice No
Customer Invoice Date
Mobile No*
WhatsApp No
Marital Status
Single
Married
Home
Owned
Rented
Vechicle
Four Wheeller Two Wheeller
No of Family Members
Children
Teenage
Adults
Date of birth
Date of Marriage
Religion
Hindu Christian Muslim Others
Credit Card
Yes No
Debit Card
Yes No
Education
Below 12th Graduate PG & Above
Income Per Month
Less than Rs 10000
Rs 10001 - 25000
Rs 25001 - 50000 Lac
Rs 50001 - Above
Occupation
Engineer
Doctor
Govt Employee
Pvt Ltd
Business
Farmer
Others
Brand owned
Home Appliance
Lap Top
Mobile
LG
Dell
Samsung
Samsung
Lenovo
Oppo
Whirlpool
HP
HTC
Voltas
ASUS
ASUS
IFB
Acer
Vivo
Sony
Apple
Panasonic
Bajaj
iPhone
Godrej
Lioyd
Videocon
Blue Star
Preethi
Index