APPLICATION FORM TO BECOME DISTRIBUTOR OF ELIXIR LIFESCIENCES



    Name of the Applicant
    Name of the Company/ Firm
    Address
    Email
    Phone No.
    Level at which you can become a Distributor District LevelState LevelLocal (For you locality)
    Do you have any experience in Distribution? YesNo
    Brief History of the Distribution of the Products you have done so far/ Details of your present Business.
    Name of the company for whom you have done distribution
    Name of Company Year To
    Last One year Turnover (INR)
    Investment Capacity (INR)

    NOTE:
    1. The information given in this form would not be used anywhere and would be highly confidential.