KEDIA INFOTECH LIMITED
Merchant Loyalty Operation Shop (MLOShop)
Application  Form

Merchant Name                 : _______________________________

Address                            : _______________________________ 

State                                : _______________________________


 Phone Number (Shop)       : _______________________________

Mobile Number                    : _______________________________

Nature of Business.           : _______________________________


 Development Center.          : _______________________________ 


Sponsor ID No.                   : _______________________________


Received by DC.                : _______________________________ 


Forwarded to KIL.              : _______________________________ 


Received by KIL.                 : _______________________________ 


Approved/Rejected on         : _______________________________


Signature of the Merchant    : _______________________________


Application Authorization


I/We wish to enroll under KEDIA INFOTECH LTD MLO program and hereby agree to be bounded by the terms and conditions of the Merchant Loyalty Operation (MLOShop) Agreement appended to this Application Form.
I/We confirm that all information provided to KEDIA INFOTECH LTD in this form is correct and accurate.
I/We certify the persons signing this application and the agreement has authority to do so and thereby binds us to the Merchant Loyalty Operation (MLOShop) Agreement. Kedia InfoTech Ltd or their representatives may contact the establishment’s Bankers or any other sources to obtain information in connection with this application.

I/We undertake to abide the rules and regulations of MLOShop and agree to follow the code of conduct and ethics of the company.

                                                              NAME DESIGNATION SIGNATURE (with Stamp)