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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 name *
Bank address *
Bank address line 2
Account number *
Authorised signatory *
Type of account
SavingCurrentOther
Other account type
Name of firm/company under which dealership exist
Sr. No
Company name
Products
Quantity
Remark
Company name *
Products *
Quantity *
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Status of firm
ProprietorshipPartnershipLimited CompanyPrivate Ltd. Co.
Partnership Deed
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(For partnership firms enclose copy of partnership Deed for Companies Memorandum Articles of Association)
Details of Proprietor/Partners/Directors
Person name
Contact number
Email address
Turnover
Last 3 years turnover
Sales tax registration no.
GSTIN no.
No. of employe
Do you have godown facility?
YesNo
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 *
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