Kisan Group

Dealers Registration Form

Name and Address of Organisation ^*
Phone no.
Fax no.
Mobile no. ^*
Contact Person ^*
Designation
Name and Address of the Banker
Type of Business	Proprietary Partnership Pvt. Ltd. Public Ltd.
Year of starting business
Turnover in past 3 years (in Rs. Lacs)

Promoters

Name ^*
Designation
Brief
Background
Is the promoter related to any of Kisan Employees?	Yes No

Professional Strength

Marketing Executive
Customer Support Officers
Skilled Laborer's
Plumbers
Others

Facilities available (kindly mention the addresses)

Office
Showroom
Godown

What do you perceive as your strengths? (Please tick and give comments if necessary)

Ability to market
Understanding of market segments
Financial strength
Establishment reputation

Which markets do you feel confident in selling?

Corporate
Industry
Retail
Education
Govt. & Govt. undertakings
Others
Which geographical areas would you like to cover?
Please give us your estimate of the total potential for our products in your area, in terms of Net Sales Value for the next 3 years
Do you undertake any local advertising for various products that you are already handling at present? If yes, what is the approximate annual outlay ?	Yes No
Any additional information which may be of relevance ?