Name of the Establishment	:
Postal Address	:
Telephone	:
Fax	:
E-mail	:
Type of Company	:	choose Proprietorship Partnership Private Ltd Limited
Date of Establishment	:	/ / (dd/mm/yyyy)
Annual Turnover: (Last 3 years)	:	Year Turnover (Rs.) Year Turnover (Rs.) Year Turnover (Rs.)
Sales Tax Numbers	:	Local Central
Premises	:	Office Owned Rented Showroom/Store   Owned Rented
Comments	:
Type of Enquiry	:	Bulk Purchase Shop-In-Shop Franchise Corporate Others
I declare that the above information is true to the best of my knowledge.