Dealership Form

Please Note: If you need a hardcopy of the filled  form, please take the print before submitting the form

Print Form

Name Of The Firm*
Telephone {Please provide STD Code}
Mobile No.*
Name Of Contact Person*
Designation Of the Contact Person*
Ownership of the firm*
Names Of the Partners/Directors*
Year Of Establishment*
Residential Address*
Residential Telephone* {Please provide STD code}
Name Of Banker* Branch
Number Of Employees*
Nature Of Business*
Area Covered by You*
Name Of The Publishers*
represented by you*
Mode Of Delivery*
Name of the transport *
Credit Period*
I hereby agree to abide by the above terms & conditions.
Name Of The Sales Executive Signature With Rubber Stamp

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