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Application Form for Dealership
 

 

Fields marked with * are compulsory
Interested For *
Products*
Name*
Designation*
Address *
Pin Code*
Phone (with STD Code)*
Fax
E-mail*
Mobile
Name of Bankers
Address of Bankers
Turnover during Last Year
Turnover during 2nd Last Year
Turnover during 3rd Last Year
Region for which you are Interested
Expected annual sale of our product in your interested Region
No. of years in this field
Willingness to invest in our Product (Rs.)
No. of Sales person directly employed
by you
Remarks:
 

For more information / queries, pls. contact:
RANJEETA GUPTA
Tel Dir. 55645941 Mob-9313357043
Tel: 011-26387915-17 Fax: 011-26387918 / 19
email: ranjeeta@milleniumsystem.com, maslinfo@milleniumsystem.com