GENERAL INFORMATION:

Name of the Dealer*

Year of Establishment

DEALER CONTACT DETAILS:
a) Head Office:

Address

Phone:

Fax:

Email*

City / District:

State:

Pin Code:

b) Marketing Office:

Address

Phone:

Fax:

Email*

City / District:

State:

Pin Code:

COMPANY INFORMATION:

Type of Ownership:

OFFICE(S) INFORMATION

Working hours (hrs):

Weekly Holidays:

KEY PERSONNEL IN THE ORGANIZATION

Designation:



Name:



Phone (Office):



Phone (Resident):



EXCISE & SALES TAX DETAILS

Excise Number:

Sales Tax:

TIN Number:

PAN Number:

SPECIFIC INFORMATION

Key financial data of the company

Please specify the business transacted with other manufacturers and your share of business with them in the following table.