Personal Information

Applicant Name *
Contact No - 1*
Contact No - 2
Email *
District *
State *

Company Information

Name of Company *
Year of Establishment *
Company website, if any
Company Official Email Id
Type of Company
Describe your current business *
Turnover of current business *
Number of customers being covered
Number of staff members handling the activities
Name of the brands already working with, if any
Proposed area of coverage
How many wholesalers/retailers network do you have?
Proposed amount of investment *