Agkem Dealership

Full Name *

Mobile No. *

Email *

Company Name *

Brands already dealing with (separated by comma)

Website

Company registered as *

Company Start Year (incorporation) *

Company registered address (Include Shop/Plot Number, Floor, Street Number, etc.) *

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City *

Pincode *

expected monthly billing *

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Upload PAN *

GST Certificate *

Upload company portfolio or catalogue

Drug License (Optional)

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Ph.: +91 9599001079email: info@agkem.com