Become a Distributor - Mosquito Magnet
BECOME A DISTRIBUTOR
Organization Name*
Name of the signatory*
Designation*
Mobile No.*
Address *
Pin*
Landmark
Landline No.
Email ID*
Website:
Additional Information


Additional information to serve you better:
Your Organization is*
ProprietorshipPartnershipPvt. LtdOthers


Expected Employee for NOL in the first month*
Monthly Turnover*
Yearly Turnover*
Tax Payer (Y/N)*
PAN/GIR No.*

GSTIN No.*


REFERENCES
Name*



Address*



Phone No.*



BANK INFORMATION
Bank Name*

Branch*
Account Number*
Account Holder Name*


Phone Number*
IFSC Code*


Account type*
SavingsCurrentRTGS/NEFT


DISTRIBUTOR BACKGROUND
PLEASE PROVIDE WHICH PRODUCTS YOU DISTRIBUTE
Products*




Started (Year)*




Turn over*




SOURCE OF FUNDING
Funds Needed (Y/N)
YesNo


Personal
Others


INFRASTRUCTURE DETAILS
Warehouse Type
RentedOwned


Space Available


License Needed (Y/N)
YesNo


If Yes, then specify
Godown/Store space*

Rental per month
Electricity backup


ANY LICENSE REQUIRED TO RUN BUSINESS IN THE PARTICULAR AREA
YesNo
If yes then specify


ANY LEGAL PROSECUTION PENDING AGAINST THE APPLICANT
*
"Yes""No"

If yes then specify
REQUIRED DOCUMENTS (Max. file size 2 MB)
Voter ID
PAN Card
Residential Proof
One Bank Reference
I hereby Delcare that all information Provided by me are true and correct in all respects.
Electronic Signature

Your Name

Date


DEMOGRAPHIC DETAILS*


DISTRIBUTION NETWORK
No. of Brands (Modern Retail)*
No. of Stores (Modern Retail)*
No. of General Stores (Modern Retail)*
No. of Institutional Clients*


INSTITUTIONAL NAME*
1.*
2.*
3.
4.
5.


REFERENCES (MODERN TRADE)
1.*
2.*
3.
4.
5.