Form for becoming Authorized Channel Partner of Modsonic Instruments Mfg. Co Pvt Ltd.




I. Basic Information :-
1. Name of the Dealer/Distributor :-
2. Permanent Address : -
Town :- State :-
City :- Phone No / Mobile No. :-
Fax No. :-
II. Constitution of Dealer/Distributor: -
3. Proprietorship/ partnership/ private/ Limited Co/Public Limited Co/ Others (Please specify) :
4. Details of Proprietors/ Directors:
Name : Address :
Contact Number: Email :
5. Particulars of Sister Concern/Allied Concern:
Name : Address :
Contact Number : Nature of Business :
6. Products/Cos. being handled.
Name of the Principal Company : Products :
Area Covered: Approx. Turnover :