DIRECT SELLER APPLICATION
Enagic India Kangen Water PVT.LTD
PRODUCTS
*
INR 2,18,000.00 - LEVELUK JRIV
INR 2,00,000.00 - LEVELLUK ANESPA DX
INR 2,77,000.00 - LEVELUK SD501
INR 2,97,000.00 - LEVELUK SD501 PLATINUM
INR 3,43,000.00 - LEVELUK K8
INR 3,97,000.00 - LEVELUK SUPER 501
SHIPING CHARGES - Select Your Deliver ZONE
*
Please Select
SOUTH - AP, Telangana, Karnataka, Pondicherry, Kerala, Tamilnadu
WEST - Gujarat, Goa, Maharastra, Madhya Pradesh, Chhattisgarh
NORTH - Chandigarh, Delhi, Haryana, Himachal Pradesh, Punjab, Rajasthan, Uttar Pradesh, Uttarakhand
EAST - Bihar, Jharkhand, Orissa, West Bengal
NORTHEAST - Arunachal Pradesh, Assam, Manipur, Tripura, Meghalaya, Mizoram, Nagaland, Sikkim
J & K - Jammu and Kashmir
PORT BLAIR - Andaman & Nicobar Island/ Special Destination
SOUTH - AP, Telangana, Karnataka, Pondicherry, Kerala, Tamilnadu
*
INR 3,000- For SUPER 501
INR 1,100 - For Other Products Only
WEST - Gujarat, Goa, Maharastra, Madhya Pradesh, Chhattisgarh
*
INR 3,000- For SUPER 501
INR 1,500 - For Other Products Only
NORTH - Chandigarh, Delhi, Haryana, Himachal Pradesh, Punjab, Rajasthan, Uttar Pradesh, Uttarakhand
*
INR 3,000 - For SUPER 501
INR 2,000 - For Other Products Only
EAST - Bihar, Jharkhand, Orissa, West Bengal
*
INR 3,000- For SUPER 501
INR 2,000 - For Other Products Only
NORTHEAST - Arunachal Pradesh, Assam, Manipur, Tripura, Meghalaya, Mizoram, Nagaland, Sikkim
*
INR 3,000 - For SUPER 501
INR 2,000 - For Other Products Only
J & K - Jammu and Kashmir
*
INR 3,000 - For SUPER 501
INR 3,000 - For Other Products Only
PORT BLAIR - Andaman & Nicobar Island/ Special Destination
*
INR 3,000 - For SUPER 501
INR 2,000 - For Other Products Only
PAYMENT METHOD
Select your Payment Method
*
CHEQUE
CREDIT CARD
NEFT
RTGS
IMPS
Payment Type
*
Full Payment
Part Payment
Transaction Details
Transaction Number
*
UTR Number
Date
*
-
Day
-
Month
Year
Date
CHEQUE NUMBER
*
CHEQUE DEPOSITE DATE
*
-
Day
-
Month
Year
Date
BANK NAME OF CHEQUE
*
Amount
*
Upload Your Proof Of Payment
*
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Describe Yourself
*
I am an Applicant and Filling this Form for Myself
I am an Up-Line and Filling this Form for My Client
PRINCIPAL INFORMATION
*
Individual
Sole Proprietorship
Partnership Firm
Private Limited Company
Others
Company Name
*
Sole Proprietor / Partner / Director Name
*
First Name
Last Name
Name
*
First Name
Last Name
Date Of Birth
*
-
Day
-
Month
Year
Date
Gender
*
Male
Female
Others
Citizen of and Resident in India
*
Yes
No
ADDRESS DETAILS - Postal Address
Please Provide your complete postal address with pin code and attach a valid address proof along with this application form. Your application will be rejected without valid address proof.
Postal Address
*
As Per your Aadhar Card/ Passport/ Election card/ Driving License/ GSTIN
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number
*
E-mail
*
example@example.com
Shipping Address
SHIPPING ADDRESS DETAILS - Please provide details below
*
Shipping to Above Postal Address
Pick-up form Bangalore Office
DETAILS OF BANK ACCOUNT
(Must Be a Ruppe Denominated Account)
Bank Name
*
A/c Details of the primary Applicant / Legal Entity.
Your Account Number
*
IFSC Code
*
Bank Address
*
Please Prove Cancelled cheque which should have the account holder's name, bank account number and IFSC code of the bank. In case the cheque dose not have the account holder's name, additionally please provide any other attested bank documents which verifies the account holder name, bank account and IFSC code of the bank.
Upload your Cancelled Bank Cheque
*
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PERMANENT ACCOUNT NUMBER (PAN) & GSTIN DETAILS
Note: In Case of GSTN Not applicable, it is mandatory to submit GSTN Declaration with application form.
PAN CARD NO.
*
GSTN NUMBER
(IF APPLICABLE)
Upload your GST Certificate (in case of GSTN)
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DOCUMENT UPLOAD
Photo Identity Proof (Attach Photocopy)
*
UDI/Aadhar Card
PAN CARD
Passport
Election Card
Driving License
Aadhar Card (Front Side)
*
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Aadhar Card (Back Side)
*
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PAN CARD
*
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Passport/ Election Card/ Driving License
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Other Documents (Optional)
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Partner's PAN CARD / Partnership Deed Marriage Certificate etc...
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Signature
*
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