Green Blossom

Fill Following Information

Registration Type *

Registered With State *

Registration Form

Full Name *

Gender *

Password * Show Password

Confirm Password

Address *

Date Of Birth

Pincode *

Photo ID Type *

Photo Id Number *

Mobile Number *

Altenate Number

Email Id *

GST No

Company Name*

Bank Details

Bank Name*

Account Holder Name*

Bank Account No*

Confirm Account No*

IFSC Code*

Confirm IFSC Code*

Upload Copy Of Passbook/Cancelled Check in Sup*

Upload One Scan Copy Of Id Proof*

Consent

Personal information on this form is collected with my permission under Section 6 of the Farm Registration and Farm Organizations Funding Act as it relates directly to and is necessary for the registration of farms / my registration as a vendor to Green Blossom Agritech Ventures Pvt. Ltd. I hereby give my consent to “Green Blossom Agritech Ventures Pvt Ltd. to use the information to determine my eligibility to its authorized Vendor’s List and share my information with third party, vendors or others as may be required for the business purposes.

I Agree