Jincare Contact
  • Jindal Medicot
  • Jindal Medicot
  • Jindal Medicot
  • Jindal Medicot
 

Distributor Form

Fill the Distributor Application Form, to become our Distributor. Our team will contact you as soon as possible
   

 Personal Details

   
*Name of the Applicant
*Address
*Telephone No. (O)    (R)
* Mobile
*Email
Constitution Proprietor / Partner / Pvt. Ltd.
Authorized Person's Name
Address
 

 Partner / Director Details

 

No.

Partner/Director Name

Relation

Address

Phone No

Age

1
2
3
4
5
 
Sales Tax No.
Local No TIN
CST No
   

 Business Details

   
*Present Business / Occupation
Present Business Status C & F Distribution Dealer
How long in Business

 Present Business Facility

 Manpower Strength

Showroom (in Sq. Ft.) Sales & Marketing
Office (in Sq. Ft.) Service
Go down (in Sq. Ft.) Office
    Go down
 

 Present Associated with

   
Total Yearly Turnover

No.

Company Name

Status

How long with Company

Yearly Turnover

1
2
3
4
5
 

 Banker's Name

       
(A) Branch
(B) Branch
 

 Present Property (Asset) Value

 
Proprietor Name Partner Value
Proprietor Name 2 Partner Value 2