Dealership Application Form

Upload Photo

Upload file size: Max 1MB. Support file format: .jpg,.jpeg, .png

Personal Information

Name of the applicant ^*

Name of the firm/shop ^*

Address of firm/shop ^*

Address line 2

Phone number with STD code ^*

Mobile number ^*

Fax number

E-mail address ^*

Bank Details

Bank name ^*

Bank address ^*

Bank address line 2

Account number ^*

Authorised signatory ^*

Type of account

SavingCurrentOther

Other account type

Company Dealership Information

Name of firm/company under which dealership exist

Sr. No

Company name

Products

Quantity

Remark

Sr. No

Company name ^*

Products ^*

Quantity ^*

Remark

Declaration

I/We do hearby declare that the information furnished herein is correct to the best of my/our knowledge and belief. For any incorrect information/mis-information furnished herein and for non-compliance of company's policies fornulated from time to time, I/We agree that:

The Company shall have the absolute right to reject my/our application form appoinment as dealer.
The Company reserves the right to terminate my/our dealership without any notice and assigned any reason.
The Company shall have the right to forfeit or adjust the whole or part of my/our Security Deposit with them in the manner they may deem fit.

Signature of the applicant(s) with rubber stamp ^*

upload signature

Dealership Application Form

Personal Information

Bank Details

Company Dealership Information

Company Information

Declaration