Dealership Questionnaire

Lab Reagents is pleased to invite Candidates who wish to represent themselves as our company Dealer.
The Candidates for the above purpose are requested to fill up the enquiries given below:

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

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