Channel Partner Form

1Applicant Details

Organization Name * Organization name is required.

Type of Business * Please select a business type.

Year of Establishment

Website

GST Number

PAN Number

2Contact Details

Primary Contact Person * Contact name is required.

Designation * Designation is required.

Mobile Number * Valid 10-digit mobile is required.

WhatsApp Number

Email ID * Valid email is required.

Office Address * Address is required.

3Business Profile

Current Business Activities

Operational Areas

City

District

State

Pincode

Team Strength

Sales Team

Technical Team

Installation Team

Total Employees

4Experience & Sales Capability

Years of Experience

Annual Turnover (Last 3 Years)

Estimated Monthly Leads

Estimated Monthly Orders

Expected Annual Revenue Potential (₹)

Major Projects Executed

Current Brands Represented

5Market Coverage & Infrastructure

Cities / Areas Covered

Customer Database Size

< 100 100–500 500–1000 Above 1000

Infrastructure Available

6Motivation, References & Documents

Why Do You Want to Partner with BIOMAN? Please share your motivation.

Reference 1

Reference 2

Documents to be Submitted

7Declaration & Submit

I/We hereby declare that all information provided in this application is true & correct.

Applicant Name * Name is required.

Date * Date is required.

🏦 Bank Details for Security Deposit (₹2,00,000)

Account NameBIOMAN SEWAGE SOLUTIONS PRIVATE LIMITED

Account No.611705090000006

IFSC CodeUBIN0561177

Address265/1, Agragaram Main Road, Ayanambakkam, Chennai, Tamil Nadu – 600095

For queries, contact:
Mohammed Dasthagir (Sales Manager): 9080816870
Mir Ayaan Ali (Marketing): 6383912648

🔒 Secure Payment — ₹2,00,000 Security Deposit

Your application will be saved first, then you'll be redirected
to our secure Razorpay payment page to complete the deposit.

Saving your application…

🏦 Bank Details for Security Deposit (₹2,00,000)

Application Submitted!