Dealer Registration form – CORBITAL CEMENT

Dealer Registration

DETAILS OF THE ORGANIZATION

Name of the Organisation : *

Address Details of Shop/ Office : *

Block *

Pin Code *

State *

Mobile Number : *

E-mail ID : *

TYPE OF ORGANIZATION (PROPRIETORSHIP/PARTNERSHIP/LTD. CO.) :

Choose type of organization

Upload Copy of Partnership Deed/Memorandum & Articles of Association / Trade Licence/GST (up to 3 documents)

File Upload

NAME & ADDRESS OF PROPRIETOR / PARTNERS / DIRECTORS :

Name :

Residential Address :

Block :

Thana :

District :

Pin Code :

State :

Marital Status :

Single
Married

Mobile Number :

Please upload Passport Size Photograph

PRESENT BUSINESS :

Name of the Co.(s) presently dealing with :

Whether Distributor/ Dealer/ Sub-Dealer :

Annual Turnover of the year just ended :

PAST EXPERIENCE IN CEMENT : AVG. MONTHLY SALES OF THE LAST 3 YEARS

Year

Brand/ QTY.(M.T.)

TOTAL QTY.(M.T.)

PERCENTAGE OF YOUR MONTHLY SALES THROUGH WHOLESALE/ RETAIL :

Wholesale % :

Retail % :

TONNAGE OF CORBITAL CEMENT YOU INTENDED TO SELL PER MONTH :

DETAILS OF YOUR BANKERS :

Name of your Bank :

Account No :

IFSC Code :

Account Type :

Branch Name :

GST REGISTRATION *

File Upload

PAN NO *

File Upload

KYC DOCUMENTS :

(UPLOAD UP TO 6 DOCUMENTS)

Choose from the drop down list

Only .jpg, .jpeg, .png, Max-size 2 MB

DETAILS ABOUT YOUR FAMILY :

I/We hereby declare that the information given above is true to the best of my/our knowledge and belief.

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