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Area Covered : State :
A) Name * : Contact Person :
Address : Area Code :
Phone - Office * : Phone - Resi :
E-mail * :
B) Background : Established in :

(Please give your suggestions, if any for better market promotion in a separate sheet)  

C) Do you agree on the terms & conditions of business as follows :
(Please click on the box)
Investment for demo piece Provide Sales Service
Regular Investment Conduct home demonstration
Payment by COD / DD Organise exhibitions

D) Do you agree to participate in the exhibition in the following manner :
Distribute handbills before launch Be present / Provide manpower during launch
Organise the venue for exhibition Approach the newspaper house for press coverage

E) Please list below the venues for launching the product thru exhibition, in order of preference :
1) Charges per day
2) Charges per day
3) Charges per day

F) Please furnish complete information about the leading newspapers circulated in your area :
LEADING DAILY Rate per col.cm
LOCAL DAILY Rate per col.cm

G) Please furnish the following details for smooth supply of goods on a regular basis :
Local S.T Regn no. Current Rate of local S.T:
C.S.T. Regn. no. Octroi.if applicable :

H) Is your area serviced by GATI or furnish name & address of two bank approved transporters?

I have read, understood and agree to the terms and condition of dealership offered to me and confirm my acceptance to the same. I am aware that the company can terminate and or appoint additional dealer in case i do not comply with the marketing procedures spelled above by the company at any point of time.


Fields marked with asterisk (*) are mandatory.
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