Customer Registration Form

Template / Sample Customer / Dealer /Distributor Registration Application Letter / Form India in word/ .doc 

ROCKET SALES LIMITED

Application form for Dealership/Customer Registration

(To be filled by Customer / Dealers)

1.         Dealership Name        :  __________________________________

            Address                       :  __________________________________

                                                  

                                                   __________________________________

           

            Town                           :  ______________ Pin : _______________

            State                            :  __________________________________

            Telephone No.            :  Office: __________  Resi. ____________

                                                   Fax : ___________   Mobile:___________

            Email                           :  __________________________________

2.         Constitution                 :  Proprietary / Partnership/ Pvt. Ltd. / Public Ltd./ HUF/Trust /

                                                   Co-operative Society / any other please specify. ____

3.         Name of the sole proprietor / partners / directors / society officials / Trustees, with residential address & telephone numbers :

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

4.         Contact Person :

                        Name              :  ____________________________________

                        Res. Address : _____________________________________

                                                :  ____________________________________

                                                : _____________________________________

                        Telephone No.: _____________________________________

5.         Sales tax registration No.   CST : _____________________________

            (A photocopy to be enclosed)

                                                         Local : ____________________________

6.         I.T. No. of the organization / PAN

            of Partners / Directors, etc.   : ________________________________

7.         Banker’s name & address with Account No. : ____________________

______________________________________________________________

8.         Annual turnover of last 3 years (Rs. in Lacs): 1^st Yr. ___  2^nd Yr. ___ 3^rd yr. ___

9.         Details of the Shop

            a )        Showroom / Shop area (Sq. Ft.)        :  _______________________

            b )        Godown area (Sq.ft. )                         :  _______________________

            c )        Car Parking Space available in front of the shop : Yes/No, Approx. Sqft.___

            d )        Location                                              : Commercial / Residential area

            e )        Visibility of the shop from the main road        :           Yes / No.

10.       Details of the nearest ________  shop

            a)         Name                          :           ________________________________

            b)         Distance from shop   :           ________________________________

11.       Details of other shops owned by the Proprietor / Partners

	Name of the Shop	Address	Companies dealing with
i ) Same  Town
ii )  Other Town

12.       Carriers / Transporters for Present _________________

a)    Supplies through Company’s carting agent/Collecting self from Company’s godown.

b)    Through Bank approved / Non-Bank approved transporter (name of  ______ )

____________________________________________________________

 13.       COUNTER POTENTIAL

( Kindly fill in the order as and when you commenced dealings with each company, starting with the company which appointed you as a _________ dealer )

Sl.No.	Name	Yr. of Starting Business with Company	Average per month (In Nos.) (during the last six months)
1
2
3
4
5
6
	TOTAL

14.

Expected off-take from  ROCKET

15.       Security Deposit                     :  Rs. _________ in words _______________

                                                            :  Chq. / DD No. _________ dated _________

                                                            :  Bank  _______________ Branch_________

16.       Non-_________ Business

            i)  Type of business (if any)    :  ____________________________________

            ii) Approximate Annual Turnover: __________________________________

17.       Reasons for deciding to deal with RCL:  _____________________________

            _____________________________________________________________

18.       I/ We have also met your Mr. __________________________ on ______________, who has clearly explained your company’s policies and I/We agree to abide by them.

  

I/We hereby declare and confirm that the details furnished above are true and correct and I/We request you to appoint me/us as one of your dealers and I/We confirm that I shall abide by all the rules and regulations of the company and our dealership is liable to be terminated, if I/We violate any of the Rocket Sales rules and regulations in relation to the business with the Company.

Signature

___________ or ______________ or _____________ or _______________________

(Prop./Karta)     (MD/CEO of Co.)      (Partner/Trustee)     (Pres./Secy. Of Co-op. Soc.)

Name              :

Date                :

Seal                 :

Enclosures :

1.            Copy of Partnership deed or copy of Trust deed or power of attorney or copy of Memorandum & Article of Association of the Company.

2.            Copies of Income Tax Return of Proprietor/each partner of company/ Trust/ HUF.

3.            Copy of Local Sales Tax No. & CST No. (If applied for attach acknowledged copy of the application made to the tax department).

4.            Indemnity Bond for supplies through non-bank approved transporter (on N.J. Paper)

5.            Security Deposit by Cheque / DD.

Details Verified by :

                                                                                    Name              :

                                                                                    Designation     :

                                                                                    Date                :

1^st Copy          -   To H.O.

2^nd Copy         -   To District Office

3^rd Copy          -   For Applicant.