1. Company Name*

Email*

Tel*

Address

Certificate of Inc. No.*

Date

2. Name of Director/Proprietor/Partner

Tel

Address

Date of Birth

3. Contact Person 1

Designation

Tel

4. Contact Person 2

Designation

Tel

5. How many Wholesalers / Retailers Network do you have?

i. Proposed Area of Coverage

ii. Location of Warehouse

iii. How close is your Warehouse to the main market?

iv. Warehouse Facilities(in sq. mtrs)

v. Proposed Amount of Investment

vi. No. of Sales Support Staff

6. Presently dealing with any competitors product(s)?

If yes, provide the following details

How long have you been with the Competitor?*

Competitor Name*

In case of our acceptance of your application, what would you propose to do with your existing Competitor's product?

7. Bank Details

Name of Bank 1*

Address*

Account No.*

Name of Bank 2*

Address*

Account No.*

Can we contact your Bankers?

8. Mode of Payment

Teller

Draft

Others

GST No.*

FSSAI Lic. No.*

PAN No.*

10. Sister Concern

If yes, provide the following details

Name*

Address*

Tel*

How related

Nature of Business

Distributor enquiry form

7. Bank Details

8. Mode of Payment