DEALER APPLICATION FORM Name of Firm Email Address of Firm Phone Number Name of Firm—Please choose an option—Sole ProprietorshipPartnershipPvt.Ltd.Ltd.Credit SocietyOther Name of Authorized Person Residential Address of Authorized Person Fertilizer Lic. No. GSTN PAN No Adhar No. Bankers Name And Address Turnover Details of Last Year Fertilizer and Micronutrients Present Distributorship Name of Companies Employee Name Upload Address Proof Upload Photo Δ PURCHASE ORDER Your Name Your Email Phone Number Product Name Product Quality Δ DEALER SUGGESTION Your Name Your Email Phone Number Dealer Suggestion Δ ACCOUNT QUERY Your Name Your Email Phone Number Your Query—Please choose an option—BalanceAccount QueryPayment Δ
