Transaction ID :
Transaction Date :
Merchant Id :
Redirect URL :
Cancel URL :
Order Id :
Amount ^* :	(Note :Min transfer should be above 500)
Currency :

Company Name ^* :
Client Name ^* :
Address Line 1^* :


Landmark :
City :
State :
Pincode :
Mobile No ^* :
Email ^* :	(Note: Please enter active email id so that all correspondence happen to this account)