Blank Distributor Application Form Template

Distributor Application Form
I. Basic Information: -
1. Name of the Applicant Distributor
(Mr./ Mrs./ Ms.)
2. Permanent Address: -
Town: City: State:

Phone No. Mobile No. Fax No.
3. Details of Immovable Properties:
(Owned by Dealer/Distributors)
II. Constitution Of Dealer/Distributor
4. Proprietorship/ partnership/ private:
Limited Co/Public Limited Co/Others
(Please specify)
5. Details of Proprietors/Partners/Directors:
Name Address& Telephone No Residence Address& telephone No Qualification
6. Particulars of Sister Concern/Allied Concern:
Name Address& Telephone No Nature Of Business Approx. Turnover

(Rs. In lakhs/Annual)
III. Manpower
7. Administrative Staff: Numbers:
8. Sales Staff:
Name Designation No. of Years Total Experience Qualification Salary
9. Details of Technical Staff: Numbers:
Name Designation No. of Years Total Experience Qualification Salary
IV. Business Associations(s):

10. Any of Your Sister Concerns/ Group Cos. Dealing with Chemicals /Lubricants? Yes/No
11. If Yes Please Mention Details:
Name Address& Nature Of Product Since Approx. Turnover

Phone Nos. Business (Year) (In Lakhs)
12. Are any of you personally related/known to any employee of Oil Company? Yes/No
Name Designation Relationship
13. 13.
Products/Cos. being handled (please attach additional sheet, if required)
Name of Company Status Area Covered Product Approx. Turnover

(In Lakhs)
V. Sales Record
Qty sold in last year Sales Turnover (last 3 yrs)
Company Brand Reference Lubricants Cutting Indl Bearings Industrial Others

Tools Spares components
VI. Financial Details

14. Firm/Company's Financial Position (As on )
Liabilities (Rs. / in lakhs) Assets (Rs. / in lakhs)
Share Capital Investment
Reserves & Surplus Fixed Deposit
Loans Properties
Creditors Vehicles
Advance from Customers Stock
Others Advances Debtors

Total Total
15. Details of Contingent Liabilities Outstanding (if any) shall also be enclosed by way of detailed note.
Name Address Telephone. O/D C/c Limit Any other No. of Bankers
Nos Limit Limit (Please
Specified)
16. Are Accounting Procedures computerized : Yes/No. If yes, the package/software:
VII. Infrastructure
17. Office Space: Sq ft Godown Space: Sq ft
Outlet Area if any Sq ft
18. Location of the office: Main market/Secondary market/Outside main township

19. Address of the Sales Counters:
Tel. Nos. Fax Nos.
20. Whether godown lies outside Octroi Zone? Yes No
21. CST No Date LST No.:
22. Name & Address of Tpt. Cos. (Ordinary/Bank approved)
23. Other modes of delivery
24. Nearest Railway Station/Transport Agency
VIII Goods:
25. You are interested in Distributorship/Dealership for: Please tick

Lubricants - Industrial Lubricants - Automotive Lubricants – Speciality
Lubricants – Food grade Lubricants – Transformer Oils Lubricants- White Oils
Lubricants – Industrial & Speciality Lubricants – Process Oils
IX. Territory
26. Name of Town/ Districts for which Dealership/Distributorship is applied
X. Investment
27. How much investment are you prepared to make for our products?
Lubricants Indl Staff/ Office / Rs.
Storage space Rs.
Vehicle for distribution Rs.
Bank Guarantee Rs
XI. Documents to be Provided:

1) Copy of Memorandum & Articles of Association in case Dealer/Distributor is a Company
registered under the Companies Act 1956.
2) Copy of List of Directors with addresses in case Dealer/Distributor is a Company registered under
the Companies Act 1956.
3) Copy of Board Resolution authorizing the person applying for Dealership/Distributorship and signing
this Form in case Dealer/Distributor is a Company registered under the Companies Act 1956.
4) Copy of Partnership Deed in case the Dealer/Distributor is a Firm, Association of Persons, etc. along
with a letter of Authority in favour of the Authorised Partner/Person.
5) List of Partners with addresses in case the Dealer/Distributor is a Firm, Association of Persons, etc.
6) Copies of last 6 months bank statements.
7) Any other documents
XIII. Declaration
I/We, the undersigned, have gone through the terms & conditions, as mentioned herein, for my/our
appointment as the Dealer/Distributor of the Company. I/We, fully understand the implications of the terms &
conditions as given overleaf and therefore bind myself/ourselves into a legal contract with
the Company as per the Indian Contract Act, 1872 and other applicable provisions and laws as may be related to
this contract. I/We understand fully that this Application Form can be used against me/us before any Court of
Law/Tribunal/Arbitration proceedings, etc. I/We, state that all information as mentioned in this Application Form
is true & correct to the best of my/our knowledge and information and I/We shall abide by and maintain the
declarations made herein. I further agree to abide by the terms and conditions of this agreement as long as I
continue to deal with the Company; I also agree to be bound by the terms & conditions & policies of supply of
goods and payment thereof conveyed from time to time by the Company.

Blank Distributor Application Form Template

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Distributor Application Form

1. Name of the Applicant Distributor

(Mr./ Mrs./ Ms.)

Town: City: State:

3. Details of Immovable Properties:

II. Constitution Of Dealer/Distributor

4. Proprietorship/ partnership/ private:

Limited Co/Public Limited Co/Others

Name Address& Telephone No Residence Address& telephone No Qualification

6. Particulars of Sister Concern/Allied Concern:

Name Address& Telephone No Nature Of Business Approx. Turnover

7. Administrative Staff: Numbers:

Name Designation No. of Years Total Experience Qualification Salary

9. Details of Technical Staff: Numbers:

Name Designation No. of Years Total Experience Qualification Salary

IV. Business Associations(s):

Name Address& Nature Of Product Since Approx. Turnover

Products/Cos. being handled (please attach additional sheet, if required)

Name of Company Status Area Covered Product Approx. Turnover

Qty sold in last year Sales Turnover (last 3 yrs)

Company Brand Reference Lubricants Cutting Indl Bearings Industrial Others

VI. Financial Details

Liabilities (Rs. / in lakhs) Assets (Rs. / in lakhs)

Share Capital Investment

Reserves & Surplus Fixed Deposit

Advance from Customers Stock

Others Advances Debtors

16. Are Accounting Procedures computerized : Yes/No. If yes, the package/software:

17. Office Space: Sq ft Godown Space: Sq ft

Outlet Area if any Sq ft

18. Location of the office: Main market/Secondary market/Outside main township

Tel. Nos. Fax Nos.

20. Whether godown lies outside Octroi Zone? Yes No

21. CST No Date LST No.:

22. Name & Address of Tpt. Cos. (Ordinary/Bank approved)

23. Other modes of delivery

24. Nearest Railway Station/Transport Agency

25. You are interested in Distributorship/Dealership for: Please tick

Lubricants – Food grade Lubricants – Transformer Oils Lubricants- White Oils

Lubricants – Industrial & Speciality Lubricants – Process Oils

Lubricants Indl Staff/ Office / Rs.

Storage space Rs.

Vehicle for distribution Rs.

XI. Documents to be Provided:

6) Copies of last 6 months bank statements.

7) Any other documents

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