Customer Registration Form
Register new customers with contact details, date of birth, address and how they found you.
Free to preview — no account needed. Using it creates your own editable copy.
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These are the real questions. Nothing you answer here is saved or submitted.
Full name*
About this template
A customer registration form captures the details you need to serve and stay in touch with a new customer: who they are, how to reach them, and how they heard about you. The last question records how each customer is happy to be contacted, so follow-ups go only where they are welcome.
Form templates collect structured information rather than opinions: contact details, enquiries, job applications, vendor registrations and complaints. Every extra field costs you completions, so start from the shortest version that still lets you act on the submission, and add fields only when you notice yourself asking for them by email anyway. Everything in this template is editable — treat the questions below as a starting point that already has the structure right, then cut what does not apply to you.
- Who should use it
- Shops, clinics, salons, gyms, coaching centres and service businesses signing up new customers — at the counter on a tablet, or ahead of a first visit by link.
- When to use it
- When a new customer joins, opens an account or visits for the first time. Share the link, embed it on your website, or print its QR code for the counter.
What this template helps you measure
- Respondent name
- Respondent phone number
- Respondent email address
- Preferred dates and scheduling
- How people found you
Every question in this template
8 questions, with what each one is doing there. Change or remove any of them after you make your copy.
Full name*
Short textWhy this matters: Captures who is answering in one short line — long enough to be useful, short enough to scan a hundred of them in a spreadsheet.
Mobile number*
Phone numberWhy this matters: The fastest channel you have for following up — an unhappy response answered by phone within an hour lands very differently from an email next week.
Email address
EmailWhy this matters: An email address is what turns a response into someone you can reply to — a confirmation, a follow-up, or the outcome once you have one.
Date of birth
DateWhy this matters: Captured as a real date rather than free text, so you can sort and filter submissions by it without cleaning the column first.
Address
Long textWhy this matters: Deliberately not a dropdown: the honest answer here varies too much between people to survive being turned into a list.
City
Short textWhy this matters: Open rather than a fixed list, because the range of real answers here is wider than any set of options would cover.
How did you hear about us?
Single choice- Google search
- Social media
- Friend or family
- Walked past
- Other
Why this matters: Makes which channel brought them to you countable: you get a ranked list you can act on rather than a pile of sentences to read.
How can we contact you?
Multiple choice- Phone call
- Please don’t contact me with offers
Why this matters: Multiple selections show which options travel together — the pairing is usually more interesting than the ranking.
How to use this template
- 1
Start with the template
Click "Use this template" and SurveyKar creates your own copy of Customer Registration Form, with every question already in place. The original template stays untouched.
- 2
Customise the questions
Reword anything that does not match your business, delete what you do not need, change a question type, or add your own. Shorter forms finish more often — cut before you add.
- 3
Add your branding
Set your logo, brand colours, fonts and background so the page looks like it belongs to you rather than to a survey tool.
- 4
Share it
Publish, then share the link, print the QR code, embed it on your site, or send it to a contact list over email or WhatsApp.
- 5
Read the responses
Results land in your dashboard as they arrive, with charts per question, filters, sentiment analysis on open text, and CSV or PDF export.
What you can customise
Your copy is yours. Nothing in the template is locked, and the original is never changed by anything you do.
Questions and wording
Edit, reorder, delete or add questions. Nothing in the template is locked.
Question types
Swap a rating for NPS, a single choice for a matrix, or add ranking, sliders and file uploads.
Logo and brand colours
Apply your logo, primary colour, fonts and background image to the respondent page.
Conditional logic
Skip questions or branch to a different page based on an earlier answer. Available on the Basic plan and above.
Thank-you page
Write your own closing message, or redirect respondents to a URL of your choice after submitting.
Sharing and distribution
Share by link or QR code, embed it on your website, or send it out over email and WhatsApp campaigns.
Frequently asked questions
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General enquiry intake form.
Job Application Form
Collect candidate applications.
Vendor Registration Form
Onboard new vendors and suppliers.
Complaint Form
Customer complaint intake form.
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