Distributor Application Form Distributor Application Form Name of your company Address of your company How long have you been operating? Less than a year 1-3 Years 4-7 Years 7-10 Years 10+ Years Number of branches (if any) Do you have own vehicle for distribution? Yes No Planning to take one Name of Applicant Phone Number of the Applicant e-Signature Kindly provide an image of the applicant's signature in PDF format for authorizing the request. Your Full Name Your Email Address Time is Up! Time's up
