Dealership Form

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NAME OF FIRM*

GST NO.* (required)

ADDRESS LINE1*

ADDRESS LINE2

CITY*

PIN CODE

COUNTRY*

NAME OF PROPRITER/AUTHORISED SIGNATORY*

MOBILE NUMBER*

CONTACT PERSON*

CONTACT PERSON MOBILE NUMBER

Email Address*

BRANDS ALREADY SELLING

NATURE OF BUSINESS:-(A) COUNTER SALE+DISTRIBUTION. (B) COUNTER SALE ONLY. (C) DISTRIBUTION ONLY.

ANNUAL TURNOVER*

NO. OF SUPPLY POINTS

APPLYING FOR (A) DISTRIBUTION (B) DIRECT DEALER

AREA OF OPERATION*

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