e-DEALER APPLICATION FORM

SECTION 1

1. NAME OF THE FIRM

2. NAME OF PROPRIETOR
3. ADDRESS

TESIL/TALUK
DISTRICT
STATE
PIN
E-MAIL ADDRESS
4. TELEPHONE NUMBER
STDCODE
SHOP
RESIDENCE
5. DATE OF ESTABLISHMENT
6. SALES TAX NO.
7. SEED LICENSE NO.
8. DETAILS OF PARTNERS/SHAREHOLDERS

% OF PERSONAL WORTH
SL.NO. NAME(S) FINANCIAL OUTSIDE OF
INTEREST BUSINESS

9. BUSINESS INTEREST OF PARTNERS IN OTHER CONCERNS

 % OF
NAME OF
NAME & ADDRESS FINANCIA LINE OF
THE
OF CONCERN L BUSINESS
PARTNER
INTEREST

10.

TYPE OF A/C
NAME & ADDRESS CREDIT LIMIT
BORROWING ON
OF BANKERS AUTHORISED
BORROWING

11. DO YOU HAVE ANY OBJECTION

TO OUR SEEKING REFERENCE FROM
YOUR BANKER/COMPANIES YOU Yes No
ARE REPRESENTING?

SECTION 2

: SEEDS AGROCHEMICALS
1. LINE OF BUSINESS
ANY OTHER
2.

ANNUAL
COMPANY PRODUCT
SINCE TURNOVER
REPRESENTED HANDLED
(IN LAKHS)

3. HAVE YOU DEALT WITH Yes No

ANY ORGANIC PRODUCTS
4. IF YES, TOTAL TURN < 1 LAKH 1-2 LAKH 2-3
 LAKH
OVER FROM
THOSE PRODUCTS 3-4 LAKH 4 LAKH >4
LAKH

< 2 LAKH 2-4 LAKH 4-6

5. TOTAL TURNOVER LAKH
FROM SEED BUSINESS
6-8 LAKH 8-10 LAKH
>10 LAKH
6. % %TURNOVER THROUGH
TURNOVER DISTRIBUTION
FROM COUNTE NETWORK
R SALE
7. SALES PROJECTED FOR ARIHANT BIOCHEMICALS
PRODUCTS

FIRST SECOND THIRD

PRODUCTM.T. 'S
YEAR YEAR YEAR

8. LIST OF MARKET
LOCATIONS PROPOSED
TO BE SERVICED
9. LOCATION OF THE
PROPOSED STORAGE FOR
OUR PRODUCTS
10. NO. OF STAFF
ENGAGED
11. NO. OF RETAILERS IN
THE NETWORK

SECTION 3

1. DO YOU OWN A
COMPUTER Yes No
2. IF YES,
SPECIFICATIONS OF THE
COMPUTER
3. IF NO, ARE YOU
WILLING TO BUY YOUR
OWN COMPUTER Yes No
AND MODEM
4. HOW WOULD YOU LIKE
ON YOUR OWN
TO BUY YOUR PERSONAL
COMPUTER BY AVAILING LOAN
I/We declare that the above information is true and correct.
My/Our concern is able to meet any commitment that I/We make
and undertake to pay your invoice bills accordingly to your terms
and conditions. I am/We are jointly and severally responsible for
all payments to be made to you.
(In case of a partnership concern, all partners to sign; in case of a
company, the authorised signatory to sign)

Place:

Date :
ARIHANT BioCHEMICALS
4th FLOOR, ‘SIRE MANSION’
No 621 ANNA SALAI, CHENNAI 600 006
TELEPHONE (044) 2829 3121
FACSIMILE (044) 4205 3466
E-Mail: arihantbiochemicals@gmail.com
arihantbiochemicals@yahoo.com