Distributor Application Form

Fssai License No: 12817013000339

Burman Brothers FMCG LLP

Phone : 9836892283 / 9051158812

Email : contact@mymasala.in

Website : www.mymasala.in

Distributor / Agency Name :

1. Authorized Person's Name :

2. Address :

3. Telephone No. / Mobile No. :

4. Email :

5. Sales Tax No.(G.S.T) :

6. PAN No. :

7. Aadhar Card No. :

8. How Long In Distributor Business :

9. Present Associated With :

10. Banker's Details :

11. Approximate Number Of Staff Of Your Own :

12. Total No. Retail & Wholesale Outlets Covered :

13. Daily Average Secondary Value :

14. Beats Name :

15. Distributor's Booking Amount :

Seal With Signature:-