MEMBERSHIP CLUB REGISTRATION FORM
Welcome to Genriam Auto Solutions Membership Club
First Name:
Last Name:
Email Address:
Phone Number:
Location/Town:
Select a Town
Nairobi
Kiambu
Embu
Mombasa
Nakuru
Meru
Murang'a
Kisumu
Eldoret
Machakos
Malindi
Nyeri
Isiolo
Makueni
Kitui
Kerugoya
Tharaka-nithi
Athi river
Awendo
Banisa
Bondo
Bungoma
Busia
Chuka
Elburgon
Eldama Ravine
Elwak
Emali
Garbatula
Garissa
Gilgil
Githunguri
Homa Bay
Isebania
Ishiara
Juja
Kabarnet
Kajiado
Kakamega
Kakuma
Kapsabet
Karatina
Which vehicles/machines do you own?
Passenger
SUV
Light Truck
Truck
Tractor
Construction Machine
Forklift
Other (specify):
How many vehicles do you own?
Preferred mode of shopping:
Online
Physical visit
Both
Preferred mode of collection:
Delivery
Fitting at the center
Preferred mode of communication:
SMS
Email
WhatsApp
Phone Call
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