Dealership

Dealer Information Form

Type of Distributor *
Offered Distribution Area *
District *
State *
Supplied by Super Stockist

Firm Detail

Name of Firm *
Type of Firm *
Name of Proprietor / Partners / Directors *
Postal Address *
Pincode *
Phone (with area code) *
Add

Contact Detail

Full Time Contact Person *
Owner / Partner Name *
Mobile No *
What's App No
Email
Manager / Clerk Name *
Mobile No *
What's App No
Email

Infrastructure Detail

Office Floor space (in sq/ft.) *
Office Ownership*
Godown / Storage Floor space (in sq/ft.) *
Godown / Storage Ownership*
Supply Vehicles owned 1*
Supply Vehicles owned 2*
Supply Vehicles owned 3*
Nos. of Delivery Boys / Booking Clerks *
Area Covered under Supply 1*
Area Covered under Supply 2
Area Covered under Supply 3
No. of Total Retail Calls *
Types of Retailers in Percentage

Business Detail

Name of this Firm*
Month & Year of Establishment*
GST Number*
CST Number*
Pan Number(Firm)*
Retail / Wholesale Drug Licence
Municipal Corporation Registration No
Total Yearly Turnover (Audited)
Accounting Software used Name
Software Version
Any Other Business Firm of Same Propriter / Partner Name
Any Other Business Firm of Same Propriter /Partner Address

Present Distributorship of other Companies

Company Name *
Company Address *
Popular Product - 1 *
Popular Product - 2 *
Popular Product - 3 *
Your Turnover (for this company) per Year *
Add

List of Documents to be Submitted (mark the attached)

Owner / Partner Photograph
Municipal Registration
State Tax Registration Certificate
Central Tax Registration Certificate
Firm Pan Card
Partnership Did
Office Photograph with Sign Board
Business / Visiting Card
Other

Terms and Mailing *