Become Retailer Registration Form

														Name *
														
														Mobile *
														
							                             Canteen code*
							                              
						                              	Establishment Nature*
						                            	
						                              	Sourcing warehouse*
						                            	
														Experience (Years) *
														
														Warehouse Size (Sq.Ft) *
														
														Budge (Lakhs) *
														
						                              Interests *
													  
														Confirm Password *
														
														Email *

Company Details

Company Name*

Establishment Entity*

Business Type*
Registered Address

Address*

Country*

Zip Code*

State*

City*

Phone No

Fax No

Mailing Address

Mailing Address same as register address

Address*

Country*

Zip Code*

State*

City*

Phone No

Fax No

Owner Name

Owner Phone No

Owner Email

Owner Mobile No
Tax Registration Details

Pan No

GST No

Tin No

Company Identification No
Finance Contact Person Details

Finance Name

Finance Designation

Finance Phone

Finance Mobile

Finance Email
Operation Contact Person Details

Operation Name*

Operation Designation

Operation Phone

Operation Mobile*

Operation Email*

Password *
KYC Documents

Copy of GST Certificate duly signed and stamped

Copy of PAN duly signed and stamped

KYC of Propritor / Partners / Director Identity proof

KYC of Propritor / Partners / Director Address proof

Tin Certificate

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Become Retailer Registration Form

Mailing Address