Distributer Application Form

	*mandatory fields
* Firm's Name:
*Owner's Name:
*Address:
*Type of Organization:
Landline No:
*Email:
*Mobile No. 1:
Mobile No. 2:
Interested in Mobile /Home appliances business :
* No. of Years in Distribution Channel:
Name of the Mobile/home appliances Brands previously worked with :
Average Monthly Sale ( In Value ) :
*Business Area ( specify cities/ Tehsils / Districts):
Bank Name :
VAT/TIN No:
A/C No :
IFSC Code :
Pan No:
Who will be directly involved in the Business:
*Willing to take Quba business for the same Area?: