IndianLPG.com

Online Dealership Registration

State :

District

Taluk/Town :

Area of Operation

1. Name of Applicant

2. Name of the Firm

3. Address (In Block Letters)

4. Residential Address of Proprietor/Partners

Phone No. Landline :

Mobile :

Alternative Mobile :

E-mail ID :

Alternative E-mail ID :

5. Family Background

6. Educational Qualifications

7. Martial Status

8. Business/Occupation

9. Godown/Land facilities with brief description

10. Financial Status

11. TIN NO./CST NO.

12. Upload Image

13.Do you have any experience of Marketing If Yes give full Details.

14. Vehicles available for Transportation of Cylinders

15.Please furnish details of any other Gas Dealership/Retailership held by you with connections/refills supplied.