Dinlog Fuel Savers Dealership Application Form
Questions marked by * are required.
1.
Product Name(s) Dealership applied for *
Petrol Saver PS110
Petrol Saver PS990
Diesel Saver GD1
Diesel Saver GD4
Tyre Spray
Dsalt
2.
Applicant's Name with father name *
3.
Business name if any
4.
PP Photo of Applicant
5.
Age of Applicant in years *
6.
Full Postal Address of Applicant in India with District, State name and Pin code *
7.
5 Villages/Taluka names with Postal Pin Code applied for Dealership *
8.
Do you have automobile or business background? *
Yes
No
A litte
9.
Mobile Number(s) *
10.
Have You fully read our Website www.dlagtech.com ? *
-
Yes
No
Not yet
11.
Your Reference Person's Name Address with Phone Number if any
12.
Email if any *
13.
Investment Proposed in Rupees *
14.
Do You agree to collect Feedback about our Products from Users / Drivers and submit to us? *
Yes
No
No Idea
15.
Any other Information or Suggestions?