Distributor Cum Applicator Form for POLY FLEX™ - MEMBRANE
All fields are mandatory.

1 COMPANY NAME
2 CONTACT PERSON
3 DESIGNATION
4 CONTACT ADDRESS
5 COUNTRY
6 CONTACT NO. PHONE     MOBILE
7 FAX
8 E-MAIL
9 YEAR OF ESTABLISHMENT
10 ANNUAL BUSINESS TURNOVER FOR LAST 3 FINANCIAL YEAR in US DOLLARS
11 PRESENT ACTIVITIES WITH EXPEREINCE IN EACH ACTIVITY
12 Excellent Contacts With
(Select one or more as applicable)
 END USERS
 ARCHITECTS
 CIVIL CONSULTANTS
 BUILDERS
 INDUSTRIES / GOVERMENT DEPT.
 APPROVAL REGISTERED WITH
13 STOCKING CAPACITY in US DOLLARS
14 MARKETING SET UP DETAILS
15 PREFERRED AREAS  
  STATE
(To enter more than one state use comma)
  CITY / COUNTRY
(To enter more than one city use comma)
    
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