Filmsure

1 Brand & Roll 2 Customer 3 Vehicle 4 Billing 5 Centre Info 6 Review & Pay

Brand & Roll Number

Select Brand

Roll Number

Box Photos

Drag & Drop or Click

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Customer Information

First Name

Last Name

Email Address

Phone Number (Primary)

+91

Phone Number (Alternative)

+91

Address Line 1

Address Line 2

City

State

Pincode

Vehicle Information

Registration Number

Chassis Number

Vehicle Company Name

Vehicle Model

Date of Application

Vehicle Photos (Front, Side, Back — 4 photos)

Front

Back

Left Side

Right Side

Billing Information

Select Protection Plan

Basic Plan 10%

₹299

Basic protection plan with minimal coverage.

Standard Plan 15%

₹449

Standard protection plan with moderate coverage.

Premium Plan 25%

₹649

Premium protection plan with extended coverage.

GST Invoice Copy (photo)

Click or drag to upload GST invoice

Invoice Value

₹

Coverage Amount (10% of invoice) ₹0.00

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Application Centre

Detailing Centre Name

Center Email

Contact Number (Primary)

+91

Contact Number (Secondary)

+91

Contact Person Name

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Review & Pay

Check your details before submitting.

Brand Name

Roll Number

Customer Name

Customer Email Address

Customer Phone No. (Primary)

Customer Phone No. (Secondary)

Customer Address

Detailing Centre Name

Contact Person Name

Detailing Centre Email

Detailing Centre Contact Number (Primary)

Detailing Centre Contact Number (Secondary)

Total Amount