Dealership AF

DEALERSHIP APPLICATION FORM

Name of the Firm *

Office Address *

State *

Country *

Telephone *

Fax *

E-Mail *

Website

Status of Company *

	Proprietorship Firm
	Partnership Firm
	Private Limited
	Public Limited

Date & Year of Incorporation *

Details of Proprietor / Partners/Directors *

Name *

Address *

Staff Strength

A. Technical *

B. Commerical *

C. General *

Name of the Bankers *

Address & Tel. No's of Bankers *

Present Distribution Business ( if any)

Manufacturer *	Products *	Area *	Annual Turnover *

Warehouse ( if any ) *

Address *

Tel.Nos *

Registration No *

ECC No *

CST No *

Service Tax No *

General

http://rawmedcol.com/

Your Interest *

Source of Finance *

Any Other Information *