Part A: Company Details

Type of Company:

Name of Proprietor/Partner/Directors:

List products distributed by your company (include your experience in CSSD, if any):

List of Products:

Product name Product type OEM name Type of Contract Year of Association
 Exclusive Non-Exclusive
 Exclusive Non-Exclusive
 Exclusive Non-Exclusive

Major achievements of your company in last  3 Months
 6 Months  12 Months:


Part B: Company Infrastructure

Branch offices(Please provide the details in a separate mail) Provide locations here:

Office setup (in sqft):

No. of Employees: Sales:

Part C: Financial Details

Turn Over(£):

Turn over:

2013-14 2014-15 2015-16

Sales commitment:


Quarter 1 Quarter 2 Quarter 3 Quarter 4

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.