Distributor Registration Form Distributor RegistrationAgent (Optional) : –Select Agent–Name of the Firm / Individual : Complete Address * : Country * : IndiaState * : –Select State–City * : –Select City–Taluka : Pincode * : Occupation * : –Select Occupation–Educational Qualification * : –Select Qualification–Constitution of th Firm * : –Select Constitution–Industry Type * : –Select Industry–Date of Incorporation * : Name of Proprietor / Partner / Director * : Contact No * : Secondary Contact No : Email ID * : Secondary Email ID : Cover Photo * : Status of Shop Godown * : –Select Status–Area of Shop / Godown(in sq.ft.) * : Other Major Distributorship : Investment Capacity * : –Select Investment Capacity–GST No (Optional) :
