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Distributorship Application Form
Questions marked by * are required.
1. Products Applied For *
  • Liquid Organic Manure
  • Cow Milk Booster
2. Name of Applicant with father name *
3. Age of applicant in years *
4. PP Photo of applicant
5. Business Name *
6. Email if any
7. Constitution of the Applicant Company
8. Address of Applicant Company *
9. Do you have agriculture background *
  • Yes
  • No
  • A little
10. Mobile number(s) *
11. Name of District Distributorship applied for with State name *
12. Amount Proposed to be invested immediately *
13. Amount Proposed to be invested in 6 months time *
14. Present Business Activity *
15. Name and Address of Partners if any
16. Premises available for Business in sft
17. Staff strength at present
18. Other infrastructure available
19. Business potential in the area applied for *
20. Any other information *