rajendraparocha.in
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URL:
https://rajendraparocha.in/
Submission: On July 05 via api from US — Scanned from DE
Submission: On July 05 via api from US — Scanned from DE
Form analysis
1 forms found in the DOMPOST /appointment
<form action="/appointment" method="post">
<input type="hidden" name="_token" value="VyZBfGCdiQ2mb6yBc7DsXEqYX9SKTYW7s9oAyVs5">
<div class="row">
<div class="col-md-4 form-group">
<lable>Name</lable>
<input type="text" name="name" class="form-control" placeholder="Your Name" required="">
</div>
<div class="col-md-4 form-group mt-3 mt-md-0">
<lable>Email</lable>
<input type="email" class="form-control" name="email" placeholder="Your Email" required="">
</div>
<div class="col-md-4 form-group mt-3 mt-md-0">
<lable>Contact Number</lable>
<input type="tel" class="form-control" name="mobileNo" placeholder="Your Phone" required="">
</div>
</div>
<div class="row">
<div class="col-md-4 form-group mt-3">
<lable>Date</lable>
<input type="date" name="date" class="form-control datepicker" placeholder="Appointment Date" required="">
</div>
<div class="col-md-4 form-group mt-3">
<lable>Time</lable>
<input type="time" name="time" class="form-control datepicker" placeholder="Appointment Time" required="">
</div>
<div class="col-md-4 form-group mt-3">
<lable>Service</lable>
<select name="service" id="department" class="form-select">
<option value="">Select Any One</option>
</select>
</div>
</div>
<div class="form-group mt-3">
<textarea class="form-control" name="message" rows="5" placeholder="Message (Optional)"></textarea>
</div>
<div class="text-center pt-3">
<input type="submit" value="Make an Appointment" name="submit" class="btn btn-primary">
</div>
</form>
Text Content
House No. 520, Sector 9, Panchkula- 134109 Call Now: 9467727411 RAJENDER KUMAR PAROCHA * Home * About Us * Services ▿ * Testimonials & Reviews * Contact Us * Make an Appointment Make an Appointment 1. 2. 3. 4. 5. SAMUHIK VIVAH DONATED Helped in Samuhik Vivah and donated of items of Kanyadan of 2 need girls. Chief guest in the opening ceremony of library in Vill. Sajuma, kaithal, Haryana. ABOUT US ABOUT OUR COMPANY Presently working as Superintendent of Customs & Central Goods and Service Tax, Govt. of India, Department of Revenue, Chandigarh Zone, Chandigarh. I joined the department in 1988. During my service, I worked in Customs and Central Excise different areas and different stations, but most of the time at Chandigarh Station. Besides from working as a government employee, since 1999, I was also a keen enthusiast and volunteered in various social events such as Rehabilitation of Youth involved with Drugs, social services, sponsoring students for higher studies (PHD and Competition Studies), waived bonded labor from bathhas, worked for the deprived and oppressed class of society. About Us Contact Us MAKE AN APPOINTMENT Name Email Contact Number Date Time Service Select Any One RAJENDER KUMAR PAROCHA Address: House No. 520, Sector 9, Panchkula- 134109 Phone: 9467727411 Email: rajendra.parocha@gmail.com USEFUL LINKS * Home * About us * Services * Photos Gallery * Videos Gallery OUR SERVICES * Contact us ABOUT US Presently working as Superintendent of Customs & Central Goods and Service Tax, Govt. of India, Department of Revenue, Chandigarh Zone, Chandigarh. I joined the department in 1988. During my service, I worked in Customs and Central Excise different areas and different stations, but most of the time read more... -------------------------------------------------------------------------------- © Copyright 2024 | All Rights Reserved | Rajender Kumar Parocha | Designed by MyDL Website Builder A product of DishaLive Group