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Dealership Form

NAME OF FIRM**

GST NO.* (required)*

ADDRESS LINE 1*:*

ADDRESS LINE 2*:*

CITY**

Email Address***

CONTACT PERSON MOBILE NUMBER*

NAME OF PROPRITER/AUTHORISED SIGNATORY*:*

MOBILE NUMBER**

CONTACT PERSON**

State*

City*

BRANDS ALREADY SELLING *

NATURE OF BUSINESS:- *

(A) COUNTER SALE+DISTRIBUTION.

(B) COUNTER SALE ONLY.

(C) DISTRIBUTION ONLY.

ANNUAL TURNOVER* *

APPLYING FOR :- *

(A) DISTRIBUTION

(B) DIRECT DEALER.

AREA OF OPERATION**