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K II Ultracentrifuge – The Choice for Industrial Scale Production
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KanHealthcare Distributor Assessment Form
Please fill the form completely for a quick decision.
Company name:
*
Name of contact person:
*
Complete office address:
*
Mobile:
*
Office telephone:
*
Email:
*
Fax:
*
Website (if any):
Type of company:
Select
Public ltd.
Private ltd
Partnership firm
Sole proprietor
Others
When founded (Mention Year):
*
Years of experience:
*
List names of companies you are associated with :
*
List names of companies you are associated with on exclusive basis and non exclusive basis. Also mention territory covered :
*
Turnover for last 3 years
*
2006 - 2007
2007 - 2008
2008 - 2009
Number of sales personnel :
*
Number of service personnel :
*
Name of your top 5 prime customers :
*
Storage facilities/Cold Room/No. of Refrigerators:
*
Minimum 2 months stock holding:
*
Yes
No
Bank Name:
*
Bank Address:
*
Drug License Number:
*
Date of Issue
Date of Expiry
Central Sales Tax Number:
*
Date of Issue
Date of Expiry
Local Sales Tax Number:
*
Date of Issue
Date of Expiry
TIN #:
*
Date of Issue
Date of Expiry
PAN #:
*