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Besure Healthcare pvt. Ltd. DISTRIBUTOR - Proposal Form

Name of the Party:-
Complete Mailing Address :- City District:
State: Pin Code Phone No. (Office)
Mobile No Email    
Residence Fax No STD Code No
Local Sales Tax No
Name of Bank & Branch Address (through which documents should be negotiated)
Constitution:    Proprietory/Partnership    No.of partners
Name of Partners/Prop
Address of residence Phone No.
Area/Territory covered Names of Districts
No.of Retail outlets covered
Storage facility : Area of Godown in sq.ft.
Security Amount Phone No. Date
Name of Transport
Average monthly business expected: First six months (Rs.)
Next 6 months: (Rs.)
Enclose:           1) Photocopy of Sales Tax Regn.,           2) Photocopy of Partnership Deed.
Photocopy of Sales Tax Regn      
Photocopy of Partnership Deed