INSECTICIDE

<form action=”#” method=”post” class=”partner-apply-form” style=”max-width:500px; margin:auto; background:#f9f9f9; padding:20px; border-radius:10px; box-shadow:0 2px 5px rgba(0,0,0,0.1);”>

<h2 style=”text-align:center; margin-bottom:20px;”>Apply as Partner</h2>

<!– Company Name –>
<label for=”company_name”>Company Name *</label>
<input type=”text” id=”company_name” name=”company_name” required style=”width:100%; padding:10px; margin-bottom:15px; border:1px solid #ccc; border-radius:5px;”>

<!– Responsible Person –>
<label for=”responsible_person”>Responsible Person Name *</label>
<input type=”text” id=”responsible_person” name=”responsible_person” required style=”width:100%; padding:10px; margin-bottom:15px; border:1px solid #ccc; border-radius:5px;”>

<!– Mobile Number –>
<label for=”mobile”>Mobile Number *</label>
<input type=”tel” id=”mobile” name=”mobile” pattern=”[0-9]{10}” placeholder=”Enter 10 digit number” required style=”width:100%; padding:10px; margin-bottom:15px; border:1px solid #ccc; border-radius:5px;”>

<!– Email –>
<label for=”email”>Email Address *</label>
<input type=”email” id=”email” name=”email” required style=”width:100%; padding:10px; margin-bottom:15px; border:1px solid #ccc; border-radius:5px;”>

<!– Total Turnover –>
<label for=”turnover”>Total Turnover *</label>
<input type=”number” id=”turnover” name=”turnover” placeholder=”Enter in INR or USD” required style=”width:100%; padding:10px; margin-bottom:15px; border:1px solid #ccc; border-radius:5px;”>

<!– Submit Button –>
<button type=”submit” style=”width:100%; padding:12px; background:#0073aa; color:#fff; border:none; border-radius:5px; font-size:16px; cursor:pointer;”>
Submit Application
</button>

</form>