Distribution form

Name of the firm *

Constitution of Firm(Proprietor/Partership/Pvt. Ltd) *

Authorised Person *

Position of Authorised Person *

Mob: *

Email: *

At: *

PO: *

Dist: *

State: *

Pin: *

Purposed Area for Distribution: *

District: *

State: *

Turn Over of the Firm Last year: *

Existing Distribuotors if Any: *

Minimum amount to be Invested in our Brand: *

Submit