Distributor Empanelment

1Basic Information

Company / Firm Name *

Type of Organization *

Year of Establishment *

Country *

Registered Address *

Operational Address (if different from above)

City *

State *

PIN Code *

2Contact Details

Primary Contact Name *

Designation *

Mobile *

Email ID *

Alternate Contact Person

Alternate Contact Number

3Business Details

Nature of Business *

Product Categories Handled *

Years of Experience in Distribution *

Current Brands Distributed

Geographical Area Covered *

Number of Dealers / Retailers Served *

4Financial Information

Annual Turnover — Last 3 Years (₹)

YEAR 1

YEAR 2

YEAR 3

GST Number *

PAN Number *

Bank Name *

Account Number *

IFSC Code *

5Document Upload

GST Certificate *

PAN Card *

Incorporation Certificate *

Address Proof *

Bank Statement *

Cancelled Cheque *

Authorized Signatory ID Proof *

Accepted formats: PDF, JPG, PNG — max 5 MB per file

6Business Proposal

What are your key business expectations and objectives in partnering with Techroutes, and how do you envision this collaboration contributing to your growth ? *

Expected Business Volume (Monthly / Annual) *

Preferred Product Lines *

7Declaration

I / We hereby declare that the information provided above is true and correct to the best of my / our knowledge. I / We agree to comply with the terms and conditions set forth by Techroutes for distributor empanelment.

Authorized Signatory Name *

Designation *

Date *

Signature Upload *

Company Seal Upload *

Fields marked * are mandatory

✓ Application submitted! Our team will review and contact you within 3–5 business days.

Distributor Empanelment Form