Name of the Company :
Address along with proof :
Telephone :
Mobile no :
Web Site :
Fax :
E-Mail :
Nature of Business :
Proprietary / Partnership / Pvt Ltd Firm :
Name of Proprietor/Partners/Directors :
Alternate Contact person :
Designation :
Year of Establishment :
Turnover during last three years :
Please attach proof :
Sales Tax Number :
Pan No. :
Excise No :
Showroom / Godown Facility :  YES NO
If Yes area in Sq.ft. :
Transport Facility :  YES NO
If Yes details :
Number of Employees & their responsibilities :
Bankers Name / Address & Account no :
How much working Capital you can reserve for distributing our range of products. :
Whether you can deposit 'Security Deposit' with the Company for distributorship. :
How much minimum sales you can assure to the Company. :
What payment terms you prefer on purchases from us or through our Stockist. :
Details of your contacts in Market Place. :
Do you or your sister company have Distributorship / Applicatorship of Construction Chemical Company products :  YES NO
If yes details :
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