New Dealership Form I accept to all conditions given "How To Become ASK Jhansi Dealer" page. If selected for dealer, I can pay Rs. 35,000 immediately. All Details Should Be Filled in English Only Your Name Phone Number 1 Phone Number 2(optional) Whatsapp Number Telegram Number Email Id Full Address Pincode Your District ---AriyalurChennaiCoimbatoreCuddaloreDharmapuriDindigulErodeKallakurichiKanchipuramKanyakumariKarurKrishnagiriMaduraiNagapattinamNamakkalNilgirisPerambalurPudukkottaiRamanathapuramSalemSivagangaThanjavurTheniThoothukudiTiruchirappalliTirunelveliTiruppurTiruvallurTiruvannamalaiTiruvarurVelloreViluppuramVirudhunagarPondicherryOther States Your Zone (for our record) ---Zone 1: Chennai Tiruvallur KanchipuramZone 2: Vellore Tiruvannamalai Krishnagiri DharmapuriZone 3: Villupuram Kallakurichi Cuddalore PondicherryZone 4: Salem Erode NamakkalZone 5: Karur Trichy Perambalur AriyalurZone 6: Nilgiris Coimbatore TiruppurZone 7: Dindigul Madurai TheniZone 8: Viruthunagar Sivagangai RamanathapuramZone 9: Tuticorin Tirunelveli KanyakumariZone 10 Pudukkottai Thanjavur Tiruvarur NagappattinamZone 11: Other States Educational Qualification Present Job Your Age Your Sex MaleFemale Do You Have GST Licence Now ? YesNo Billing Name (If you have GST, give company name otherwise give personal name) Adhar Number or GST of Billing Name Product Delivery Location (If you are in a village, specify the name of your nearest town) We will send through regular lorry service. You have to pickup from your delivery location. Fill the Following Details Carefully Areas you want to become dealer (one area name per line) Pincodes you want to become dealer (one pincode per line) All these pincodes must be within 10 km radius. For village areas we give relaxation for up to 15 kms. You are responsible for shop supply as well as free door delivery of these pincodes. So please dont give pincodes which are very far away because it will be difficult for you to give door delivery. These information could not be changed for next six months. So please select carefully. After submitting this form, send your name and address to the telegram number 790 456 9575. If there are no dealers in your area, we will process your application immediately.