Dealer Application Form

DEALER CREATED BY
Name SUMIT CHABR

ADD NEW DEALER

First Name Middle Name Third Name
MR. KAMALJIT * JOSHI
KNOW YOUR CUSTOMER
Pan No. Mobile No. 9814592005 *

Cst No. Off Landline No.

Lst No. Email Id
Contact Person KAMALJIT JOSHI
DEALER BANK
Bank Name
Branch Name
Address
OFFICE DETAIL
Type Of --Select--
Company
Company JOSHI GIFT CENTER
Name *
Address VPO KALA SANGIA
Pin 144601*
State PUNJAB
District KAPURTHALA
City KAPURTHALA
BUSINESS DETAIL
Type Of Dealer --Select--
Dealer A
Category
Type Of
ELECTRICAL --Select-- *
OutLet
Already Dealing in --Select--
DTH
If Yes Brands --Select--
Avg Monthly Bill 0
DishTV(Expected
Avg Monthly Bill 0
TataSky(Unit)
Avg Monthly Bill 0
 Airtel
Avg Monthly Bill 0
reliance
Avg Monthly Bill 0
Sun
Avg Monthly Bill 0
FTA
Avg Monthly Bill 0
Vediocon
No. Of Units 0
Monthly Approx
FUNCTINAL DETAIL
--Select--
Size Of Shop *
Service / Inst.
YES*
Infrstructure
Give Service YES*
Does
YES*
Insatllation
Does After
YES*
Sales Service
Computer /
NO*
Internet
No. Of Sales
Person
--Select--
Retail Chain *
VC No.1 01512336751*
VC No.2 01512336752*
Disributor Id
154176*
To Be Tag
DS Name *
DishTv Branding
Glow Sign --Select--

Non Lit Glow --Select--

Sign
Flanges --Select--

In Shop --Select--
Branding
Recharge Bussiness
Sell Cards NO*
Does Recharge NO*
EPRS NO*
Totl Recharge
5000
Value Per
*
Month

Submit