{"id":1031,"date":"2025-08-27T23:40:23","date_gmt":"2025-08-27T18:10:23","guid":{"rendered":"https:\/\/bpahm.com\/?page_id=1031"},"modified":"2025-08-27T23:40:25","modified_gmt":"2025-08-27T18:10:25","slug":"wholesaler-registration-form","status":"publish","type":"page","link":"https:\/\/bpahm.com\/hi\/wholesaler-registration-form\/","title":{"rendered":"\u0925\u094b\u0915 \u0935\u093f\u0915\u094d\u0930\u0947\u0924\u093e \u092a\u0902\u091c\u0940\u0915\u0930\u0923 \u092b\u0949\u0930\u094d\u092e"},"content":{"rendered":"\n<style id=\"wpforms-css-vars-1026\">\n\t\t\t\t#wpforms-1026 {\n\t\t\t\t--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 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form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1026-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1026-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-1026-field_1-error\" required><label for=\"wpforms-1026-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1026-field_1-last\" class=\"wpforms-field-name-last 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type=\"number\" id=\"wpforms-1026-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" step=\"any\" aria-errormessage=\"wpforms-1026-field_3-error\" required><\/div><div id=\"wpforms-1026-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1026-field_4\">Company \/ Shop Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1026-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-1026-field_4-error\" required><\/div>\t\t<div id=\"wpforms-1026-field_9-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"9\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1026-field_9\" >Name Shop Agreement<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1026-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1026-field_5-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1026-field_5\">Country <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1026-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled >--- Select Choice ---<\/option><option value=\"India\"  selected='selected' class=\"choice-5 depth-1\"  >India<\/option><option value=\"Afghanistan\"  class=\"choice-6 depth-1\"  >Afghanistan<\/option><option value=\"Bangladesh\"  class=\"choice-7 depth-1\"  >Bangladesh<\/option><option value=\"Bhutan\"  class=\"choice-8 depth-1\"  >Bhutan<\/option><option value=\"China\"  class=\"choice-9 depth-1\"  >China<\/option><option 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required=\"required\"><option value=\"Andhra Pradesh\"  class=\"choice-4 depth-1\"  >Andhra Pradesh<\/option><option value=\"Arunachal Pradesh\"  class=\"choice-5 depth-1\"  >Arunachal Pradesh<\/option><option value=\"Assam\"  class=\"choice-6 depth-1\"  >Assam<\/option><option value=\"Bihar\"  class=\"choice-7 depth-1\"  >Bihar<\/option><option value=\"Chhattisgarh\"  class=\"choice-8 depth-1\"  >Chhattisgarh<\/option><option value=\"Goa\"  class=\"choice-9 depth-1\"  >Goa<\/option><option value=\"Gujarat\"  class=\"choice-10 depth-1\"  >Gujarat<\/option><option value=\"Haryana\"  class=\"choice-11 depth-1\"  >Haryana<\/option><option value=\"Himachal Pradesh\"  class=\"choice-12 depth-1\"  >Himachal Pradesh<\/option><option value=\"Jharkhand\"  class=\"choice-13 depth-1\"  >Jharkhand<\/option><option value=\"Karnataka\"  class=\"choice-14 depth-1\"  >Karnataka<\/option><option value=\"Kerala\"  class=\"choice-15 depth-1\"  >Kerala<\/option><option value=\"Madhya Pradesh\"  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