Name*	Mr. Ms.
E Mail
Address of Office*
City*
State*
PIN*
Phone*
Area of Office	(sq. ft.)
Address of Godown*
City*
State*
PIN*
Phone
Area of Godown	(sq. ft.)
Area	--Select-- Rented Owned
Proximity to Market: The place mentioned above is away from the main market as per details mentioned below:
Product category	Kilometer away from market
a) I.T. / Computer and peripherals
b) Consumer Durables
c) Mobile
Please tick on the documents available and also provide a copy of the same.
Regn under Service Tax Regn under Sales Tax PAN Regn under Shops and establishments Act
(Press "Ctrl" key to select more than one option)
The list of previous clients, if any handled in the capacity of Consignment Agent or C & F is as follows:
Address	Turnover
Investment capacity/plan (in Rs.)