Firm Name *
Designation/Department *
Name *
Gender *
PAN No. * Company Service Tax No.
Mobile No. * Phone with STD Code
Member Mailing Address
Address Line 1 * Address Line 2
Post Office * Land Mark
District Pin Code *
State * City *
Email Id *
Residential Mailing Address Same as Above
Address Line 1 * Address Line 2
Post Office * Land Mark
District Pin Code *
State * City *
Personal Details
Date of Birth *
(yyyy/mm/dd)
Marital Status *
Spouse Name
Spouse Date of Birth
(yyyy/mm/dd)
Anniversary Date
(yyyy/mm/dd)
Booker Business Details
Other Business Type
Other Preferred Hotel Names
Hotel 1 Hotel 2
Hotel 3 Hotel 4
I have read and accept the Terms and Conditions of the Citrus Program.