Dealer Enquiry Form – Vigour
Dealer Enquiry Form

    Firm Name

    Proprietor Name


    Firm Address

    Fertilizer Selling License No.

    Valid up to

    GST No.

    Adhar Card No.



    (Please provide correct mob. & whatsapp number, because all future communication will be initiated on these numbers only)

    Business Details

    Company Name

    Agencies Name

    Omex business plan for current year (Please tick mark in appropriate box)
    Up to Rs. 50,000/-Rs. 50,000-1 lakhRs. 1 - 2 LakhAbove Rs. 2 Lakhs

    Self Declaration
    I hereby declare that, the above given details and information is correct and true to my knowledge. I would liketo go ahead for Omex Preferred Dealership.

    Copy attached
    1. Fertilizer Selling License
    2. GST Certificate
    3. Owner Adhar Card