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Distributor / Dealer Application form
Basic Information
Name Of The Applicant :
 *
Application Requested By :
Company Name :
 *
City :
 *
State / Province :
 *
Country :
 *
Zip Code :
 *
Telephone (enter country/city code, if applicable):
 *
Fax :
E-mail :
 *
Website :
Contact Information
Shipping Address Marketing Address Accounts Address
Name :
Address :
City :
State / Province :
Country :
Zip Code :
Telephone:
Fax :
E-mail :
 *
 *
 *
 *
 *
 *
 *
 *
Local Sales Tax Number (Indian Distributor/Dealer) :
Central Sales Tax Number (Indian Distributor/Dealer) :
PAN Identification Number (Indian Distributor/Dealer) :
VAT Number (Overseas / Indian Distributor/Dealer) :
Year Established :
Business Status :
Nature Of Business :
Total Number Of Employees :
Products Details
Products Handled Description Manufactured By Arrangement *
Note: * Please mention the nature of arrangement such as Exclusive, Non-exclusive, Agent, Importer, Dealer, Distributor, Representative, Liasioning agent, etc...
Business Details
List of Existing Customers/Sector:
List of Potential Customers/Sector:
Annual Turnover :
Products Category :
 Accessories    Couplers & Pneumatics   
Potential Volume
Existing Volume of Similar Products :
Required Volume of Our Products :
Investment Planning
Existing Investment on Similar Products :
Planned Investment on Our Products :
Bank References
Bank Name :
 *
Address :
 *
A/c No :
 *
Fax :
E-mail :
 *
Aim
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