Dealer Enquiry Preliminary Form - India
Customer / Dealer Name * :
Contact Person Name * :
Designation :
Address * :
State * :
Postal ZIP Code :
Phone No * :
Mobile No :
Fax No :
E-Mail ID * :
Nature of Business * :
Year of Establishment * :
No of Employees :
Currently Dealing with * :  

 
Area of Operation Request for * :
Potential for JANATICS Products in your Area * :
Whether Dealing with Pneumatic` Products * :

1. Specify the Existing Product name with No of Years and
    the annual Value of Purchase




Describe the Current Activity
If already aware of pnematic products, please furnish details of others activities :
: Enter the word you see in the image on left side*
* - Mandatory Fields