Dealer Application

Select State * Andaman Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chattishgarh Delhi Goa Gujarat Haryana Himachal Pradesh Hyderabad Jammu And Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharastra Manipur Meghalaya Mizoram Nagaland Odisha Other Puducherry Punjab Rajasthan Sikkim Tamil Nadu Telengana Tripura Uttar Pradesh Uttarakhand West Bengal

Select District *

Planned Date of Commencement Business

Outlet Type: New Existing

Proprietorship * Partnership Private Limited Company

Details of Proprietor in proposed Entity   Self Father Mother Brother Sister Wife Employee Friend Other Proposed Stake GOEEN Dealership (%) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100

Basic details about Business Grow (Last Year)

Annual Gross Turnover Lest Than 1 Cr 1 Cr To 10 Cr 10 Cr to 20 Cr More Than 20 Cr

Type of facilities proposed

Select Workshop size 1-500 Sq.ft 501-1000 Sq.ft More than 1000 Sq.ft

Details of existing / proposed facility

Showroom in main market area	Yes No
Facing main Road	Yes No
Select Frontage Area 10-15 ft 16-20 ft 21-25 ft 26-30 ft More Than 30 ft
Chose Total Covered Area 1-500 Sq.ft 501-1000 Sq.ft More than 1000 Sq.ft
Workshop & Warehouse Floor Area 1-500 Sq.ft 501-1000 Sq.ft More than 1000 Sq.ft

Attach Pictures of Proposed Facility
Applicant Person Photo	Showroom Front Facing	Showroom Interior View
Choose File	Choose File	Choose File
Showroom Road facing	Workshop Front Facing	Workshop Interior View
Choose File	Choose File	Choose File

* File size will be less than 250kb

Investment & Sources of Funds
Total investment planned for facilities

Amount of Security Deposit to be paid to GOWITH GREEN E-VEHICLES PRIVATE LIMITED
Make Sure All Mandatory Field are Filled Up