| 1. Name in which Dealership Desired |
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2. Address for communication with Tel / Fax Nos. |
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3. Any associate companies (Name & Addresses) |
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| 4. Total Capital employed in |
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| (1) |
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| (3) |
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| 5. Details of Promoters / Directors / Partners |
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6. Details of Office / Showroom Size & Location |
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7. Details of Godown / Showroom Size & Location |
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| 8. Details of Transport available |
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9. Details of Other companies dealership Godown / Turnover |
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| 10. Activities in (1) with turnover |
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| 11. Activities in (3) with turnover |
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| 12. Major client base |
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13. Business commitment for 1st year for items where dealership is sought |
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| 14. Estimated annual growth of business |
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| 15. Bankers |
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| 16. Registrations |
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| i. Shop & Establishment Act Regn. No |
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| ii. Central Sales Tax Regn. No. |
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| iii. State Sales Tax Regn. No. |
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| iv. Income Tax G.I.R. No. |
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| v. Permanent Account No. |
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