Dealer Registration Form

Join our network of successful dealers and grow your business with us

Basic Info

Business

Location

Interest

Additional

Consent

Review

Basic Information

Please provide your basic contact details

Full Name *

Mobile Number *

Email ID *

WhatsApp Number

Business Details

Tell us about your business background

Business Name *

GST Number (Optional but useful)

Years in Business *

Nature of Business *

Companies Currently Dealing With

Annual Turnover *

Location Details

Specify your business location

Search Village / Pincode *

State

District

Mandal / Taluka

Village / Town

Pincode

Dealer Interest

What products are you interested in dealing with?

Interested In *

Bios

Pesticides

Sprayers

Mulching Sheets

Others

Existing Customer Base (No of Farmers) *

Additional Information

Help us understand more about you

How did you hear about us? *

Supporting Document (GST Certificate/Proprietary ship document/Partnership Deed/Registration Certificate)

Choose file or drag & drop

Additional Comments

Consent & Agreement

Please review and accept our terms

I agree to be contacted by Pasura Crop Care Pvt. Ltd. for dealership opportunities.*

I agree to receive promotional messages from Pasura Crop Care Pvt. Ltd.

Review & Verify Details

Please review all information before submitting your application

Basic Information

Business Details

Location Details

Dealer Interest

Additional Information

Consent & Agreement

Application Submitted Successfully!

Thank you for your interest in becoming our dealer. We will review your application and contact you within 2-3 business days.

Application ID: