CHANNEL PROFILER- DEALERSHIP FORM
Prospective Dealer Introduction Form
Enterprise Data
Name *
Address *
Full Postal Address (Official)
Contact # *
Landline with STD Code
Entity Nature *
Financial Data(Enterprise Sales Turnover) *
Last Financial Year (Audited)
Business Data
List the companies( brands) you are dealing with currently? *
What is the product range you are dealing in? *
Patient Monitor, Defibrillator...
Territories Covered *
States & Districts
Accounts Covered (Private Segment) *
Required
Segments Covered (Government Segment) *
Required
Organization Data
Promoters Data( Name,Qualification, Contact # , Email ID) *
Employer Strength # ( Sales, Servicing) *
Opportunity Data
What Brands you are interested in? *
Required
What Products you are interested in? *
Eg: Waldmann Derung- Hospital Lights-Emergency/Minor OT/Mobile
Required
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