Akzo Nobel India Limited

Site Supply Intent Form

Dealer Name - Site Reference no -
Dealer Code - Site Address -
Contractor Name-
Contractor Code-
Depot Name -
Date -
Valid Upto -
PRO SO Name -
PRO ADM Name -

Dear Sir,
We are happy to inform you that we will be supplying Akzo Nobel Products at the above mentioned site on agreed rate of
discount agreed with you are mentioned in the table below for recording purpose.
The following is a statement of our intent and should be read completely & your signature with stamp should be affixed at the end.

A. Akzo Nobel will deliver the material on the site on behalf of the dealer. The decision to supply paints to this customer / contractor
rests solely with the dealer at his discretion.
B. Akzo Nobel is not liable for collection of payments from any customer / client neither in part or full.
Responsibility of all the collections from the customers / clients is solely with the dealer.
C. The above mentioned rebates are applicable only for material which is delivered by Akzo Nobel directly to the site mentioned
above. This rebate would not be applicable to any other material either delivered by you or purchased through any other sources
D. The below rebates are given on the invoice itself and are inculsive of ATR & QTR for channel 74 billing unless
any other support agreed and duly written tie-up signed by the dealer and company.
Segment ( Tick the Appropriate Segment) Name ( Tick the Required products) Ltr/Kgs Size Rs/Ltr
Builder WS E1000
Re-painting WS Ultra Clean
C.P WS ELASTOMERIC
Govt WS Projects
AQUATECH FLEXIBLE BASECOAT
Ext Sealer E900 / Sealer E1000
VT /Solitaire Stain/SOLITAIRE A1000
Distemper- (IAD / Magick)
Int Sealer A700/SBCP/A500 )
Gloss
Satin Finish/WB Satin
MID: Ext E700 / Int A700

I have read & understood the statement of intent by Akzo Nobel India Limited and accept the same in its entirety

For Akzo Nobel India Limited

For ______________ Dealer's Name .

Zonal Manager – PRO

Date - __ /__ / ____ Authorised Signatory .

Place Dealers Sign and Stamp .