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* Mandatory Fields

1 Details of the applicant firm
* a) Name of the Firm :
b) Year of Establishment :
* c) Establishment Address :
* d) Tel No. (Office) :
(Fax No.) :
* (Mobile) :
* Email :
e) Concerned person & designation : :
f) Name of the Banker & Address :
2 Experience of selling Indl. Piping System        :
3 a) Details of promoters of the firm :

Name of the Promoters

Eduactional Qualification

Nature of Experience

* b) Is Promoter related with any of the employee : Yes No
of SHIVA. If yes, give details     Name of employee : Relation :
4 Details of organization setup :
No. of employee             : Office              Field       
No. of service Mechanics : Skilled Labours Plumbers others
*5 Details of major product lines dealing at present :



Area Covered

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6 Details of the various offices and godown of the firm :

City where office is located with Address

Area of godown if any with Address

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7 Total sale value of the firm for last three years :


Sale (Rs. in lakhs)

8 Details of the best customers of the firm :

Name of the Customer

Category Sold

Approx. annual sales to them

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9 District/towns proposed to be covered :
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10 Justification for distributorship :
a) Marketing plans for the Industrial piping products in brief :
b) Sales Promotional activities :
i) No. of existing retail outlets :
ii) Industries/Institutions being catered to at present :
11 Sales assured by the firm to the area proposed :



Estimated business in the first year
(Rs. in lakhs)

12 Value of stocks that can be held by the Firm :    
If appointed as our Dealer you shall be required to tender security deposit amount, mutually agreed upon at the time of appoinment.
Place : Name of the responden :
Date : Designation :

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