Welcome to Aquadana

Distributorship Form

ASHMINA LIMITED

APPLICATION FOR AQUADANA TABLE WATER DISTRIBUTORSHIP

Applicants Name:
Business Name:
Phone Number:
Email Address
Contact Person
Date of Birth
Address
Residential Address 1:
Residential Address 2:

NATURE OF BUSINESS

How long has the location been in existence
Are you distributor to any other company?
If yes, name the companies and the products
What turnover (cartons) are you doing for these companies:
Name your Bankers:

DISTRIBUTOR

Reference 1

Reference 2

Name:
Occupation:
Address:
Mobile No: