| Puma - Fleet Card Portal

Customer Information

Company*:

Company Name on Card*:

Legal Name*:

Nature Of Business:

Entity*:

Company Address 1*:

Company Address 2:

Company Address 3:

City*:

Company Phone 1:

Company Phone 2:

Mobile #*:

Email Address*:

Fax #:

Contact Person*:

Contact Designation*:

NTN #:

Sales Tax Reg.:

Authorized Signatory*:

Auth Desig*:

Due Date*:

Billing Frequency*:

Monthly

Fortnightly

Credit Limit*:

Service Charges*:

Create Customer

Sno	Company Info ID	Legal Name	Company Name Card	Date	Business Type	Contact Person	Entity	City	Address 1	Phone 1	Mobile	Apporved	Edit