StayFit

Distributor Registration

Name of the Distributor (Firm/Company) ^*

Permanent Address ^*

Business/Shop/Godown address ^*

Name of the Owner ^*

Telephone Number

Mobile Number ^*

Email Address ^*

Full Name ^*

Mobile Number ^*

Constitution of Distributors ^*

GST Number ^*

PAN Number ^*

Drug Licence number

Food Licence number

Name of the Bankers ^*

Name of the Top Transporter Approved by Bank ^*

Number of years experience as Distributor ^*

Number of companies
deals with ^*

Total number of Chemists deals with ^*

Turnover of
previous Year ^*

Name of the Five Top Customers/companies ^*

Number of adminstrative staff ^*

Number of sales staff ^*

Office Space in sq ft ^*

Office Space is ^*

Godown Space in sq ft ^*

Godown Space is ^*

Outlet Area if any in sq ft

Outlet Area is

Location of the Office/Godown ^*

Name of the territory applied for Distributorship ^*

Whether willing to operate under ^*

Advance payment

Credit

Do you have any other business other than Pharma/Food ^*

Yes

Name

Address

Turnover

If any other Information about your Firm/Company

I hereby declare that the details furnished above are true and correct to the best of my knowledge.