New Customer Registration Form

cim26:

exercice/https://www.jotform.com/build/93105469250354
Nom Prénom *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
E-mail
que pensez vous de cette exercice ? *
Other *
Feedback about us:
Suggestions if any for further improvement:
Will you be willing to recommend us?

Yes Maybe No

Please give reference of any two people whom you feel:

	Full Name	Address	Contact Number
1
2

Should be Empty:

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