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  Please use the below form to Apply for Distribution / Dealership.
  Fields with * are mandatory.
 
   
Please select your choice: *
Name of the Firm: *
Address: *
Status of the Firm:
Name of Proprietor/Partner/Director: *
(as the case may be)
Address of Proprietor/Partner/Director: *
(as the case may be)


(PIN)
Telephone/Fax: * Phone: STD code:
  Mobile: Fax:
Year of Establishment
Address of Shop *
Address of Godown *
Details of Bankers * Name of Bank:
  Address:
  A/c No.:
Details of Securites viz Bank Guarantee
Details of Vehicles owned (If any)
District(s) where Distributorship wanted *
Details of Storage facility * Covered Stock Yard Area: (Sq. Mtrs)
  Godown Capacity: (Metric Tones)
Details/Distributor of any other (Presently Appointed) (Company)

(Goods/Brands)

(Quantity)

(Value)
Expected Monthly Sale
(SRMB Product)
Sales Tax Reg. No. * (State)

(Central)

(TIN)
Referee
Occupation Name Address & Tel no
Note: Referee of present company for the Dealer/Distributor is working will be preferred
Scanning
Note: Documents to be produced (As the case may be)
(a) Trade License
(b) Copies of Balance sheets of past 2 years
(c) Copy of Sales Tax Registration
(d) Banker's Certificate
(e) Copy of Memorandum and articles of association/Partnership deed
(f) Site Plan with approximate distance from nearest town
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