Raj Wafers
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Agency Form
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Desired Area For Agency
State
District
Taluka
Personal Information
First Name
Middle Name
Last Name
Address Information
Current Address
*
Pin Code
State
District
Taluka
Contact Details
Tel Number 1
Tel Number 2
Mobile No 1
Mobile No 2
Company Name
Email Id
Partners Information
First Name
Middle Name
Last Name
Partner Address
Permanent Address
*
Pin Code
Taluka
District
State
Partner Address
Other Experience Detail
Storage Facility
Yes
No
If yes, Mention Godown Size in Sq.Ft.
Transport Facilities
Yes
No
If yes, Mention Vehicles Details
Your investment capacity ?
From 10 to 15 Lakhs
15 Lakhs or More
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First
Last
Email
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