Application form for distributorship

Vopec is an established company in herbal pharmaceutical Industry. We produce vast categories of capsules, nutritional and food supplements, syrups, herbal formulations and oils for various ailments. In our expansion programme, company has decided to extend its distributor ship to the other parts of India, for which your valuable support is needed.

If you are interested please fill in the application form below and we will get back to you soon. We are looking forward for a lasting, mutually fulfilling and highly fruitful business association.

Name of the Working Area   Block Name / Ward  
District   State   Pincode  

Application For  
1. Name of the Firm  
2. Nature of the Firm  
3. Names of Partners / Directors
1.   2.  
4. Address of the Firm
(Rubber stamp Preferable)
5. Contact Person and Designation  
6. Contact Nos. with STD Codes
Code No Res Off
Mobile Fax Email
1. Year of establishment
2. Nature of Business
3. Annual Turnover ( Approx. )
4. Brands dealt with
1. 2.
3. 4.
5. Office space
6. Branches / Dealers (if any)
1. 2.
3. 4.
7. Customer base
8. Godown space
9. Banker's Name & Address
10. Bank limit enjoyed
11. Outstanding litigation,if any
12. Sales Tax Registration details
13.No. of Employees
Managers Salesmen
Technicians Delivery Boys
14. Any achivements / appreciation from the principal companies :
1. Product Interested In

I do hereby declare that the information furnished above is true to the best of my knlowledge and belief.I hereby apply for distributorship of Vopec Pharmaceuticals.