Technology Transfer
 
* Required Fields  
  Name of Distributor  
  Address :
   
  Registered Office  
  Marketing Office  
 
  Phone No. :
     
  Rggistered Office No.   -   (STD Code)-(Phone Number)
             
  Marketing Office No.   -   (STD Code)-(Phone Number)
             
  Residence   - (STD Code)-(Phone Number)
             
   
  Mobile    
  Fax No.      
  E-mail (eg. abc@xyz.com)    
  Name of CEO  
   
  Name of Contact Person/with their Designation :
   
  Technical  
  Commercial  
 
   
  Year of Establishment    
  Years of experience     
   
  At present dealing with (Name of the Equipments/Company Specially) :
   
1.    
2.  
3.  
4.  
   
  No. of Total Staff    
  No. of Sales Executive/ Engineers     
  No. of Service Engineers
  (After Sales & Service) 		   
  Area/States covered   
  Name of your Bankers   
  Web address 
  (if handling net marketing)		  
   
  If handling agency / distribution of any other   company, Please the name of the company   and products handled, with area covered
 
   
  Government business :
     
  2nd Last Year    
  Last Year    
  Current Year (till today)    
     
   
  How much you can invest in our   products/projects    
   
  Can you offer after sales service
 
  Coverage in Govt. Hospitals Pvt.Hospitals/   Nursing homes    
Expected monthly Sales (Expected Appx.)   Telemedicine Solution
     
  Any Comments    
  Vat No.