Application for Dealer / Distributor Registration
Company Details
Dealer
Branch Town Distributor
Upcountry Distributor
Select Dealer Status
Upload Photo
Company Name *
Contact Person Name *
Email ID*
Contact no *
Street Address *
Apartment, suite, etc *
City*
State/Province
ZIP / Postal Code
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Panama
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Virgin Islands, U.S.
Wallis and Futuna
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Zimbabwe
Select Country
Date of commencement of busines
Income Tax PAN No.:*
Please Provide Photocopy of Pan Card*
GST No.*
Please Provide Photocopy of GST Certificate*
Sole Proprietorship
Partnership
Private Ltd. Co.
Public Ltd. Co.
Other(to specify)
Type of Business entity:
Please provide supporting documents
Full Details of
Proprietor
Partner
Directors
Full Details of
Name
Phone
Street Address
City
ZIP / Postal Code
Qualification
Ownership
involvement in Firm / Company
Business History:
Dealership
Manufacturer / Supplier Name to dealership
Since (Year)
Product Group
Annual Gross Turnover
%age TD
Territory in which you propose to operate:
Town
State
District
Details of Present Managerial and Sales Staff
Name
Position
Qualification
No. of Years of Experience
Salary
Responsibility
Showroom
Yes
No
In Main Market Area
Yes
No
Facing Main Road
Yes
No
Off Main Road in a lane
Address
Frontage of Showroom (in ft.)
Area (Sq. Ft.)
Warehouse
Location
Total Floor Area (Sq. ft.)
Whether completely waterproof / fireproof
Bank Details
Name
Bank Name
Account No.
IFSC Code.
Branch
Telephone No.
I/We certify that the information given in the application form is correct and complete.
Name & Signatures of Authorised Signatory with Official Seal.
Name
Designation
E-Signature
Official Seal
List of Enclosures (in Photocopy)
Copy of Firm's Partnership Deed /Company Memorandum
Copy of Shop License
Passport Size Photo of Owner/s
Banker's Letter of Reference
Submit
