Dealer/Distributor/Business Associates Query Form »
Please complete the form below:
Please fill correctly all the fields corresponding to the statements in red.
* Name of Organisation :
« Please Enter a valid Name of Organisation
Name of District/Territory of Primary Business Interest :
Type of Organisation :
Business Address :
*Contact Person :
« Please Enter a valid Contact Person
Contact References :
*Phone No. :
« Please Enter a valid Phone No.
*Fax No. :
« Please Enter a valid Fax No.
*Cell No. :
« Please Enter a valid Cell No.
*E-mail :
« Please Enter a valid Email
*ST/CST or VAT/TIN No. :
« Please Enter a valid ST/CST or VAT/TIN No.
Companies presently represented :
Presently represented area(s) of Business Networking :
Annual (Last Two Years) :
Expected Turnover (Current Year) :
Network status :
(How many clients catered)
Years in Distribution Business:
(In Years)
Do you own a retail outlet also :
Counter Sales  
Number of Sales/Delivery Assistants : Local Supplies  
Usual Mode of Business Operation :
Relationship Selling :
Supplies against Order :
Supplies Execution Time :
Delivery System
(√ Tick which is appropriate)
: Courier     Transport     Bus/Train
Regular Area wise Van / Jeep
Business Terms with your purchasing clients : Cash     DD     Cheque at Par
How would you like to associate yourself for your business working with us? :
Please inform which system of working you would like to opt for your convenience. : Security based i.e. A fixed amount is taken as Security on which the company pays an annual simple interest @ 9.00% p.a., as well as fixes a credit limit of 30 days for its clients.
Goods against advance payment through Cheque at par / DD
Tell us more about your working system as adopted by yourself for Sales & Distribution of OTC / FMCG based Ayurvedic Products (as much as you can) :
A Final Question :
How seriously are you interested to join us as our business associate? :
*Type Verification Code :
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