Firm Name*

Address*

Year Established

Contact Person*

Telephone Number

Mobile Number*

GST No.*

Nature of the Firm
ProprietorshipPartnershipJoint familyAny other

Managing Proprietor / Partner Name

Bankers Name & Address

Transporter Name

Distributor Facilities

No. of Salesmen*

No. of Tricycles

No. of Autos*

No. of Vans

Number of Outlets in Your Area

Provisional Shop*

Tea & Bakery Shop*

Pooja Store*

The Area covered by you for the present products:

Route 1*

Route 2*

Route 3*

Route 4*

Route 5

Route 6

Route 7

Route 8

Note: van marketed covered by weekly once-twice in a month-monthly once

Present Companies & Turnover Details

Company 1

Company 1

Product Distributed at present

Turnover / Month

Supply From
CompanySS

Company 2

Company 2

Product Distributed at present

Turnover / Month

Supply From
CompanySS

Company 3

Company 3

Product Distributed at present

Turnover / Month

Supply From
CompanySS

Company 4

Company 4

Product Distributed at present

Turnover / Month

Supply From
CompanySS

Company 5

Company 5

Product Distributed at present

Turnover / Month

Supply From
CompanySS

Stamp / Dealer Signature

Consent
I confirm the above details are true and agree to be contacted for verification.