Lords Automative Pvt. Ltd.

B-506,Cello Trump I.B. Patel Road, Jayprakash Nagar Goregaon (E), Mumbai
400063 Email: info@lordsauto.com : web: www.lordsauto.com

Application for Dealer/Distributor Registration*

Dealer Status: Dealer

Branch Town Distributor
Photo
Upcountry Distributor

1 Company Name:
2 Contact Person Name
3 Contact Person Mobile No.
4 Registered Address:

District
State
Pin Code

5 Telephone Numbers
Fax Nos.
Cell Phone No.
E-Mail ID

6 Date of commencement of business:

7 Income Tax PAN No.:

(Please Provide Photo Copy of Pan Card)

8 GST No.
(Please Provide Photo Copy of GST Certificate)

9 Type of Business entity:

Sole Proprietorship Private Ltd. Co.
Partnership Public Ltd. Co.
Other(to specify)
(Please provide supporting documents)

10 Full Details of
Proprietor Partner Directors

Involvement
Name Address & Contact No. Qualification Ownership in Firm /
Company

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 Lords Automative Pvt. Ltd.
B-506,Cello Trump I.B. Patel Road, Jayprakash Nagar Goregaon (E), Mumbai
400063 Email: info@lordsauto.com : web: www.lordsauto.com

11 Business History:
Specify dealership and other business. In case some more dealership are in the name of
your sister concerns or associations, please give details.
Manufacturer / Product Annual
S. No. Dealership Supplier Name Since (Year) Group Gross %age TD
to dealership Turnover

12 Territory in which you propose to operate:

Town District
State

13 Details of Present Managerial and Sales Staff

No. of Years of
S. No Name & Position Qualification Experience Salary Responsibility

14 Showrooms
Showroom 1 Showroom 2 Showroom 3
In Main Market Area (Yes / No)
Facing Main Road
Off Main Road in a lane
Address
Frontage of Showroom (in ft.)
Area (Sq. Ft.)

15 Warehouses
W/H 1 W/H 2
Location
Total Floor Area (Sq. ft.)
Whether completely water proof /
fire proof

16 Bank Details
Name
Bank Name
Account No.
IFSC Code.
Branch
Telephone No.
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 Lords Automative Pvt. Ltd.
B-506,Cello Trump I.B. Patel Road, Jayprakash Nagar Goregaon (E), Mumbai
400063 Email: info@lordsauto.com : web: www.lordsauto.com

I/We certify that the information given in the application form is correct and complete.

Name & Signatures of Authorised Signatory with Official Seal.

Name

Designation

Signature

Official Seal

List of Enclosures (in Photocopy)

a) Copy of Firm's Partnership Deed /Company Memorandum
b) Copy of GST Certificate
c) Copy of Shop License
d) Passport Size Photo of Owner/s
e) Banker's Letter of Reference

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