DEALER & DISTIBUTOR REGISTRATION | LYQA TECHNO SOLUTIONS PVT. LTD

DEALER & DISTIBUTOR REGISTRATION FORM

BUSINESS CONTACT INFORMATION
Title *	Date Business Commenced *	Photo *
Company Name *	Date Business Commenced *
Phone \| Fax *	Type of Business * Sole Proprietorship Partnership Corporation PVT LTD
E-mail *
Registred Company Address City, State Zip Code *
BUSINESS AND CREDIT INFORMATION
GST No: (Attach copy) *	Bank Name: *
PAN No: (Attach copy) *	Account Number: *
BANK STATEMENT LAST 3 Months (Attach Copy) *	Type of Account: *
SECURITY CHEQUE NO. *
PERSONAL INFORMATION FOR ALL DIRECTORS AND PARTNERS
Name of Proprietor	Name of Proprietor
Address	Address
PAN NO.	PAN NO.
Aadhar no.(Attach copy)	Aadhar no.(Attach copy).
Date Of Birth	Date Of Birth
BUSINESS/TRADE REFERENCES
Company Name	Phone
Address	Fax
City,State ZIP Code	E-mail
AGGREMENT
All Invoices are to be paid 21 days from the date of the invoice. Claims arising from invocies must be maid within seven working days. By Submitting this application, you authorised LYQA TECHNO SOLUTIONS PVT. LTD to make inquiries into the banking and business/trade refrences that you have supplied. We Agree to accept the Credit Limits as sanctioned to us and will abide with your credit policy. We shall provide security and PDC before each Billings as per LYQA TECHNO SOLUTIONS PVT. LTD policy. We agree to pay interest on delayed payment @24% P.A. and cheque return charges Rs.500/- per return instrument.
Declaration: I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

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