Authorised Retailer

Note :- * Mark mandatory field.

Through (Company Sales Person)^***

Designation^***

Depot / SS Town Name^***

State^*

Name of Firm^***

Office Address^***

Correspondence Address

Delivery Address^***

Contact Person Name^***

E-Mail ID^***

Phone No. (with STD code)

Mobile No.^***

Key Person Profile

Name (person to deal with)^***

Residence Address^***

Education^***

Business Experience (in year)^***

Date of Birth^***

Marriage Anniversary

Business Profile^*

Partners Name

Partners Address

Present Company (Associated Brand)

S.N.	Company Name	Product	Brand
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2
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Business Information

Area of Operation (Proposed) :-

S.N.	Town Name	Distance From Head Quarter
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2
3
4

Weekly off Day:-^***

Bank / Payment Details:-

Name of Bank^***

Account Type^*

Mode of Payment^***

Security Amount (if any)^***

Name and Address of Two References Full :-

Name^***

Address^***

Relation With^***

Contact No^***

Full Name

Address^*

Relation With

Contact No^*

Terms & Conditions

1. I/we agree to abide by the terms and conditions of the Company given and as may be amended from time to time.

2. The Payments must be timely as per company's norms.