CHANNEL PARTNER APPLICATION FORM – A

(To be filled by the Channel Partner)

1. Full Name of the Applicant …………………………………………………………………

2. Name of the firm (attach visiting card) …………………………………………………………………

3. Type of the firm …………………………………………………………………

(Proprietor/Partnership/Private)

4. Complete address of the firm …………………………………………………………………

…………………………………………………………………

5. Contact details – Mobile …………………………………………………………………

-- Landline …………………………………………………………………

6. Email id …………………………………………………………………

7. Interested in Aerocon products  CPVC SWR

(tick the interested options)  UPVC Others

8. Years in business …………………………………………………………………

9. Turnover expected annually in Rs …………………………………………………………………

10. Current Business lines :

BRAND PRODUCT ROLETURNOVER ( Lacs/Mth )

1
 1.

2.

3.

11. PAN Number …………………………………………………………………

12. GST Number …………………………………………………………………

13. Income Tax Number / TAN …………………………………………………………………

14. Expected business in lacs per month:

Aerocon CPVC Pipes & Fittings …………………………………………………………………

Aerocon UPVC Pipes & Fittings …………………………………………………………………

…………………………………………………………………

Total …………………………………………………………………

15. Number of sales staff …………………………………………………………………

16. Godown Details (Size, Location) …………………………………………………………………

17. Number of retailers in your Network ………………………………………………………………..

18. Expected sales from your counter …………………………………………………………………

19. IT Details : ( Please the IT Support systems available at your shop )

Laptop/Computer:  Internet  Printer 

2
 S No: Name of the Shop Contact Person Cell No: Address Turnover (Lacs / Mth)

Top retailer details

19 Security Cheque Details

a. Cheque # ………………………………………………………..

b. Drawee Bank ………………………………………………………..

c. Dated …………………………………………………………

The above particulars are true to the best of my knowledge and belief. Any change in information will
be intimated to you immediately.

Date: Signature of Applicant ( with firm seal )

___________________________________________________________________________________________________________

Mandatory Documents to be attached with seal and sign:

1. One passport size photos of applicant(s).

2. Two visiting cards of the firm.
3. Attested copy of address proof.
4. Attested copy of PAN No:
5. Attested copy of GSTN:
6. Aaadhar copy
7. Authorization letter Except Proprietorship firms