Su-Kam Trade Relationship Programme

Dealer Registration Form

Concern sales/service person details

Select Distributor State*

Name of Distributorship*

Name of the Dealer*

Name of the Dealership*

Profile of the Firm*

Proprietorship

Partnership

Private Limited

Dealer VAT/CST/TIN N.

Shop Address*

City*

State

Phone 1 **

Phone 2 **

Phone 3**

Mobile**

Residential Address

City

State

Phone

Please tell us about your Family :

Spouse's Name

Dealer DOB*

Spouse’s DOB

Marriage Anniv.

Dealer association with the distributor* :

Less than 1 year

1 yrs. - 2 yrs.

2 yrs. - 5 yrs.

More than 5 yrs.

What all products you sell?*

	Inverters / HUPS (upto 1500 VA)
	Batteries / Battery trolley
	Solar products (Inverters, panels, chargers, charge controllers etc & Solar home lighting system)
	Battery chargers & Accessories
	High Capacity Inverters (2.5 KVA & above)
	UPS (On Line & LI)

Monthly Average Value of Business with Su-Kam Products.*

	Up to Rs. 10,000		Rs.10, 000 – Rs. 30,000		Rs. 30,000 – Rs. 50,000 .
	Rs 50,000 – Rs. 100,000		Above Rs. 100,000

Have you ever qualified in the Su-Kam scheme before, if yes, please mark which one.

Su-Pariwar

Su-Uday

I hereby declare the information furnished above is filled-in with my due consent and authority.

* Mandatory, ** Fill Phone or Mobile Number