This form was created and is being processed using the free version of allForms, a web form service. If you find the page below to be suspicious or fraudulent, please
Dinlog Agent/Dealership Application Form
Questions marked by * are required.
1. Products Applied For *
  • Petrol Saver
  • Organic Manure
  • Cow Milk Booster
  • Tyre Saver
2. Name of Applicant *
3. Email: *
4. Company Name if any *
5. Constitution of the Applicant Company *
6. Address of Applicant Company *
7. Phone Numbers *
8. Applied For *
9. Area Desired *
10. Amount Proposed to be invested immediately *
11. Amount Proposed to be invested in 3 months time *
12. Present Business Activity *
13. Name and Address of Partners if any
14. Premises available for Business in sft
15. Staff strength at present
16. Staff strength proposed in 6 months
17. Other infrastructure available
18. VAT Regn number if any
19. Business potential in the area applied for *
20. Any other information *