HARITHA AUTOMATION - DISTRIBUTORS REGISTER

NOTE : Please Fill Up The Required Fields

Become A Distributors

01 Distributors Details
02 Distributors Company Address
03 More Information
04 Bank Details
05 Contact & Login Details

Distributors Name *

Name of Company *

Identity Key

Legal Status *

Distributors Category *

Distributors State *

Distributors Zone

Turnover for Last Financial Year *

No.of Year Associated with Maxsell *

Door No *

Building Name

Street Name *

Area / Location *

State *

Select City *

Landmark

Country *

Pincode *

GST No *

Default Tax (%)

PAN No *

GST Certificate (PDF FILE) *

GST information provided by buyer will be final and no amendments will be made once invoice is generated under any circumstances.
It is buyers responsibility to make sure that GST number shared is accurate and matches GST records.
To avoid discrepancy buyers are advised to attach GST certificate.

Account Type *

Name of the Bank *

Bank Account No *

Branch *

NEFT IFSC CODE *

Paytm / Google Pay Registered Mobile Number

Bank ID Proof (PDF File)

Area of Operation

Major Segments that you are Dealing

Other Products that you are dealing

Serviceable Area *

Contact Person Details

Sales Person Name

Sales Person Phone Number

Sales Person Email ID

Account Person Name

Account Person Phone Number

Account Person Email ID

Service Person Name *

Service Person Phone Number *

Service Person Email ID

Dispatch Person Name

Dispatch Person Email ID

Dispatch Person Phone Number

Secondary Contact Person Details

Name of the Person

Mobile No

Land Line No

Email Id

Fax No

Distributors Login Details

Primary Username *

Email ID *

Mobile *

Password *

Confirm Password *