*Name	:
*Company Name	:
*Street Name	:
*Suburb	:
*Pin	:
*City	:
Fax	:
*Email	:
*Contact No.	:	Please write STD code and Phone number separately.
*STD Code	:
*Phone	:
Mobile No.	:
Pager No.	:
Please register me for	:	Junagarh Bhilwara Ganganagar Bhatinda Ferozpur Jammu Hoshiarpur Yamunanagar Haridwar Haldwani Meerut Faizabad Begusarai Guwahati Dibrugarh Jorhat Gangtok Bardhaman Bhilai Karimnagar Tirupati Thanjavur Kollam Kannur Shimoga Sangli Akola Dhule
Designation:	:	Proprietor / Senior Partner / MD / Chairman / CEO Channel Manager Business Manager Sales Manager Service & Support
Company Type	:	Sole Proprietorship Partnership Private Ltd
Year the company was founded	:
Number of employees	:

How often do you check email ?

Daily 4-5 times / week 2-3 times / week Not at all Does your company source from manufacturers/importers and sell to resellers/traders? source from distributors and supply to end users? source from distributors and supply to other traders/retailers? have a retail operation?

Do you supply to customers in other cities?

If yes, which cities? 1)      2)  3)

Who are your main customers? Also indicate percentage of sales in that category:

Home User  :  % SME  :  % Large Corporate Users  :  % Government  :  % Other Traders %

Whether an authorized partnership (eg. Genuine Intel Dealer, Seagate SSP, Genuine Logitech Dealer, Canon Empowered Partner)

Please specify:

Name 3 of your top-selling products & their brands

Products	Brand	No. sold per month

I would like to invite my business associate or partner for this event :
1st Partner
His Name	:
His Company Name	:
His City	:
His Email ID	:
Contact No.	:	-
		STD No.     Phone No.

2nd Partner
His Name	:
His Company Name	:
His City	:
His Email ID	:
Contact No.	:	-
		STD No.     Phone No.