Drishti Biotech Pvt. Ltd.

DEALERSHIP/ DISTRIBUTORSHIP APPLICATION FORM

Name of Firm*

Address *

Taluka*

District *

Pin No. *

Contact Person

Mob. No.*

E-mail*

Residence Address *

Taluka*

District *

Pin No. *

Year of Establishment

GST No*

IT PAN No. of Firm & Partnership

Name of Associated Firms & its Activity: (If required attach sheet)

Name & Place

Activity

Details of Area of Operation under Dealership

Annual Turn Over

Name of Bank & Branch

Account No.

Preferred Transporters

Preferred Couriers

Details of Present dealership with other Agrochemical, / Fertilizer / Bio companies/Insecticides/Seeds etc.

Name of Company	Products	Annual Sales	Deposit

Your Approx Commitment of Annual Turn Over of DBPL Product Range in Rs

Facilities for Field Work
No. of Two wheelers No. of Four wheelers No. of Manpower

Business Setup

Type of Infrastructure
Shop Owned / Rented Facility Area (in Sq. Ft.) Online Sales Platform Other (Please specify)

Store/Warehouse Facility Area (in Sq. Ft.)

TERMS & CONDITION FOR DEALERSHIP/ DISTRIBUTORSHIP
(1) To avail distribution of DBPL Product range in the area of we are agreed to deposit Rs. (Rupees only in words) towards interest free security deposit.
(2) Agreed not to return any materials of confirmed order to the company, if at all dues to any unavoidable circumstances’ sales return will the made on my/our own cost of transportation, GST etc. whichever expenses are applicable.
(3) Agreed to give two blank security cheques No. & of Bank branch in favour of Drishti Biotech Pvt. Ltd. Ahmedabad as security cheque for recovery of unpaid balance payments by the company whenever required.
(4) Promise not to do any activity to hamper the image of the company & its products as well as unnecessary market spoilage of price & Product.

ACCEPTANCE
I/We am/are willing to get dealership of Drishti Biotech Pvt. Ltd. for areas. All the information filled in this dealership form is true. Also, we promise to obey all terms & condition of the company for dealership in present and future.

Date

Witness

Dealer Registration Form

Farmer Registration Form

Dealership Application Form

DEALERSHIP/ DISTRIBUTORSHIP APPLICATION FORM