DISTRIBUTOR APPLICATION FORM

Full Name of Applicant

Name of the Firm:

Dropdown Select (Type of Firm:)

*PAN Number

*GST No

*Contact Person Name

*Phone Number

*Alternate Phone Number

*Email

*Complete Address for Communication

*Pincode

*Experience in FMCG/Spice Distribution (Years):

*Current Brands Handled (if any):

Area Interested for Distributorship:

Godown Space:in Sq. Ft.

No. of Delivery Vehicles:

No. of Sales Staff:

Monthly Investment Capacity (in Rupees):

Bank Name:

Branch:

Bank Account Holder Name:

Account No.:

IFSC Code:

Cancelled Cheque Upload

X

*Photo Upload

*AADHAR Upload

*Store Image Upload

GST CERTIFICATE Upload

X

*PAN CARD Upload

*SIGNATURE UPLOAD

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