Member form

Please use only Netscape Communicator 4.7 or IE 5.0 or higher versions for submitting this form. See the Member Area for additional details:

BASIC INFORMATION
(All fields marked with * are mandatory)

First Name*

Last Name*

Address Line 1*

Address Line 2

Country *

Zip/PIN*

(Please do not change city or state if it is automatically generated)
City*

State*

Daytime Phone

Home Phone*

Fax

Email*
(Your email is also your login id)

Choose a password*

Repeat password*
(Password fields are case sensitive)

MEMBER HOME PAGE

If you have your own home page, GlobalBengal Initiatives invites you to link your site with bengalcommerce.com in the Member pages area. This will enable more people to see your web site. We request you to put a similar link to our site from your home page. PLEASE NOTE that sites containing adult material or promoting violence or fanaticism will be removed. GBI reserves the right to remove any inappropriate links from this page.

Do you want us to create a link between your site and GBI?

Yes No

If you selected yes above, please type in the URL of your site:

Please provide a one line description of your site:

Please classify your site as:

OTHER PREFERENCES

Frequency of travel to India/Bangladesh:

Which of the following product categories would you be interested in?
(Please hold down the control key and click for multiple selections)

Do you shop for products online?
Yes No

Any other preferences or comments.

I hereby certify that the information submitted above is accurate and true to the best of my knowledge. I understand that as an e-commerce company, GlobalBengal Initiatives Inc is legally required to maintain correct information of all its members. GlobalBengal Initiatives reserves the right to cancel my membership at any stage, with or without notice, if it believes that my membership information is incorrect or incomplete.

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