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Devi Cropscience Pvt.

Ltd
Kolkata
Distributors/Dealer Appointment Form
1)Name of the Firm

-----------------------------------------------------------------

2) Address of the Firm

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------E mail id: ___________________________________________

3) Phone No:-

-(o)-------------------(R) -------------------cel----------------

4)Concern Person From Firm

------------------------------------------------------------------

If it is partnership Firm . Mention the partners details


----------------------------------------------------------------------------------------------------------------------------------------------------------------------------5) Whether firm is registered. Give the details :- (Attach the photocopy of Tin No)
VAT No----------------------------------------------------------------------------TIN No-----------------------------------------------------------------------------C.S.T No ---------------------------------------------------------------------------6) How long firm is in Agro Business : -----------------------------------------------------------------7) How many manpower

: ---------------------------------------------------------------------

8)Details of Godown

:-Area------------------------------------------------Sq.ft.
:-Address-----------------------------------------------------------

9)Name and Address of your bank:---------------------------------------------------------------------------------------------------------------------------------------------10) Whether you have credit limit with Bank----------------------------------------------------------(Mention the details)
11) Interested area you are interested for our product -----------------------------------------------------------------------------------------------------12)Transporter details:-(Which comes daily from Kolkata,Hajipur,Ranchi,Guwahati to your place)
For Office Use
Credit limit fixed --------------------------------Credit days fixed--------------------------------------Area allocated

-------------------------------

Signature of the
Dealer Distributors

Verified
SR/SO

Approved by
Zonal Manager.

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