MEDIKWALITY.COM

Application Form To Become/Stokist/Distributor/Sub-Distributor/Retailers Of Medikwality.Com

Level at which you want to apply:

Registration Fee Rs.1500/-

Registration Fee Rs.1000/-

Registration Fee Rs.750/-

Registration Fee Rs.500/-

Do you have any experience of FMCG/

Pharma/Wholesale/Other distribution?

Brief History of the products of the distribution business you have done so far

Brief History of the products of the distribution business you have done so far

If not then give detail of your present business:

Name of the company whom you have already done the distribution

To

To

To

Last one year turnover:

Investment Capacity:

If not then give detail of your present business:

If you accept the above terms and conditions and are ready to give us all the information’s mentioned above then please attach this
application form and send to Email ID: info@medikwality.com

Note

1. Stockiest & distributor should have CST No.(If not please apply)
2. Pan card / Address proof & account mandatory for all category(If not send form 60).
3. No medical license required
4 Account settlement on every 15 days.
5. Medikwality.com reserves the right to reject or accept any application without
6. assigning any reason however the information given in this form would not used
7. anywhere would be highly confidential.
8. Once the registration is done the company has sole authority to select and investigate
9. the space and other facilities as per the norms then only will accept the security amount.