Distributor Form

Personal Information

First Name

Last Name

DOB : DD/MM/YEAR

Email Address

Primary Contact No

Secondary Contact No

Education Details

Current Address

Company Information

Company Name

Company Email

Company Address

Pincode

Type Type Proprietorships Partnerships

Other Business Information

Current Nature of Business

Storage Facility Storage Facility Yes No

Transport Facilities Transport Facilities Yes No

Vehical Details

Area of Coverage (Tehsil)

Warehouse Facilities Warehouse Facilities Yes No

Size Of Warehouse (In sq ft. Mtrs)

Distance Between Main Market & Warehouse

Your Investment Amount

Working Capital