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(Note: All the information filled in here will be kept confidential)

*Name of the Organization:
*Address With PIN code:
*Year of Establishment:
*Name of Proprietors/Partners/Directors:
*Tel Nos. Office:
Country Code:	Area Code: Tel No.:
Mobile No.:
*Fax (with STD code):
Country Code:	Area Code: Tel No.:
*Email :
Web-site:
Closing Day/Weekly off:		Working Hrs.From:		To:
*Office Space:
*Showroom/Godown Space:
A. Technical Personnel:
1.0) Name : Qualification : Experience :
2.0) Name : Qualification : Experience :
3.0) Name : Qualification : Experience :
*B. Sales Personnel:
1.0) Name : Qualification : Experience :
2.0) Name : Qualification : Experience :
3.0) Name : Qualification : Experience :
4.0) Name : Qualification : Experience :
5.0) Name : Qualification : Experience :
*A) Are you manufacturing any items?	Yes No
B) If yes, since when: Type & products Manufactured:
*you are planning following functions through own staff:
*Promotion: Yes No	*Installation: Yes No
*After Sales Service:	Yes No
*State S.T. / TIN No.:		*C. S. T. No:
Octroi % for our products in your town:
*Area desired by you for Promoting our Products i.e. State / Dist. City please specify names :

*For which products you would like to take up dealership for : (If specific)

*Present Agencies for representation / selling:
Name of the Company	Products handled	Types of Industries covered	Areas Towns covered for this company	Agency since which year








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*Name:
*Designation: