"; } $adminemail="sales@indusorganics.com"; $adminemail2="ash@techxpertindia.com"; $headers = "From:webmaster@indusorganics.com \nContent-Type: text/html"; mail($adminemail,"New Account Application(IndusOrganics)",$body,$headers); //mail($adminemail2,"New Account Application(IndusOrganics)",$body,$headers); echo "
Thanks For your request,We will get back to you after processing your request.

Close Window
"; die; //redirect("corpaccount.php"); } ?> ACCOUNT APPLICATION AT INDUS ORGANICS

You may also download the form in PDF format & email/post to our office address.
ACCOUNT APPLICATION AT INDUS ORGANICS
Company Info
1) Business Name ">
2) DBA ">
3) Physical Address ">
4) City ">
5) State ">
6) Zip ">
7) Phone ">
8) Fax ">
9) Email ">
10) Website ">
11) Type of Business
12) State of Registration ">
13) Contact Person ">
14) Fed. Tax ID ">
15) E-Mail ">
16) Year of Business Formation ">
17) Additional Info: