Name of Company
Start date of Establishment
Type of Company: Private Ltd Public Ltd Partnership Proprietership
Key Contact Person
Registered Office Address
Name of Proprietor/Partner/Directors:
Local Sales Tax No:
Central Sales Tax No:
List products distributed by your company (include your experience in CSSD, if any):
Branch offices(Please provide the details in a separate mail) Provide locations here:
Office setup (in sqft):
No. of Employees: Sales:
Kindly attach a company profile along with the dealer information form.
I hereby certify that the above information given are true and correct as to the best of my knowledge.