1. Dealer Name : |
* |
2. Address of Regd. Office/Showroom : |
* |
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Phone : |
* |
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E-mail : |
* |
3. Contact Person : |
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Phone : |
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E-mail : |
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4. Organization Proprietorship / Partnership / Company : |
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5. List of Directors :
(Name, Address & their Phone No.) |
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6. Dealership / Stockistship held of
other
Companies : |
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7. Storage Facilities : |
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8. List of Customers : |
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9. Business Turnover : |
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10. Expected turnover with Lab Reagents: |
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11. Tax Details : |
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Central Excise No. : |
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TIN No. : |
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LST No. : |
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CST No. : |
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PAN No. : |
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12. Bankers Name, Address and Phone No. : |
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Type of A/C
(CA / SB / CC) : |
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13. No. of Employees : |
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14. No. of Vehicles : |
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*
Statements given above are true to the best of my knowledge and I / we abide by that |
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