DISTRIBUTORSHIP APPLICATION FORM
(You are requested to kindly fill all the information asked for )
1). PRODUCTS & AREA APPLIED FOR
Products
:
State
:
District
:
2). PERSONAL PARTICULARS OF MAIN PROMOTER (WHO RUNS DAY TO DAY BUSINESS)
Name
:
Age
:
Address Residence
:
Address Office
:
Phone
:
Area
Code
Number
Mobile
:
Fax
:
Area
Code
Number
Email
:
3). PARTICULARS OF THE FIRM/ CO. IN WHICH DISTRIBUTORSHIP IS APPLIED
Name of Firm/ Co.
:
Address
:
Phone
:
Area
Code
Number
Fax
:
Area
Code
Number
Email
:
Website
:
Numbers of Years in Business
:
Line of Specialisation
:
-- Select --
Ortho
Others
( If other pls specify)
Brief Description of your exiting Business
:
Products Dealing in & Agencies/ Distrbutorships Held
:
Annual Sales Turnover
:
Number of Employees
:
Sales
Others
Mkt. Area of Strength
:
-- Select --
Govt.
Corporate Hospitals
Retail
Small Hospitals
Clinics
Please give us brief idea of your marketing system
:
4). DETAILS REGARDING PROPOSED BUSINESS
Please give us an Assesment of the market scenario for our products in your area
:
Please list present commpetitors of our product in your area
:
Expected Monthly sales volumes
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Minimum Guarantee of Monthly Sales of our Products by you
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Margin of profit Expected by you on MRP (In %)
