Supplier Registration form
(for Expression of Interest )
( All fields are mandatory )
Commodity
(select the items from the list)* :
Redgram DAll
Bengalgram / Chana Dall
Sugar
Wheat Atta
Double Fortified Salt
Vermicelli
Jaggery
Ghee
Fortified P.Oil
Raagi(Small millets)
Non-woven carry bags
Name of the Firm* :
Supplier Type:
Production Capacity* :
supply Capacity* :
License Nos.* :
Experience to Govt.agency * :
Annual Turnover* :
Contact Details
Contact person Name:* :
Address 1 * :
Address 2 * :
City * :
pincode * :
Primary Mobile No * :
Secondary Mobile No * :
E-mail * :