ACL Dealership Registration

DEALERSHIP APPLICATION FORM

1. Organization Name *

2. Enter your Full Name? *

3. Email *

4. Alternate Email *

5. Contact *

6. Alternate Contact *

7. Company GST? *

8. Please provide the company 10-digit PAN (Permanent Account Number)

9. Please select the type of entity. *

Proprietor / Partnership

Private Limited Company

Public Limited Company

10. Please specify your experience in the polymer industry? *

1-2 Years

3-5 Years

Above 5 Years

Above 10 Years

Above 20 Years

11. Monthly Material Consumption / Sales? *

ABS

PMMA

SMMA

GPPS

HIPS

POM

K-RESIN

LDPE

HDPE

UHMWPE

PVC

SAN

WOOD PLASTIC

ACRYLIC SHEET

PET

12. Primary Industries Served by you? *

Automotive

Home Appliances

Textile

Kitchen / Tableware

Cosmetics

Toys

Lighting

Jewellery

Medical

Sanitary Hardware

Construction / Building Materials

Packaging

Engineering

Sheet / Rods / Profiles

Furniture

Other

13. Which ACL business model are you interested in? *

ACL Authorized Gold Agent in your territory.

ACL Authorized Gold Dealership in your territory (If you have a warehouse/distribution center)

14. Please specify the Territory/Region you intend to operate as an ACL Agent/Dealer. *

15. What is your company current financial year sales in quantity (mt)?

16. What is your company current financial year sales in value (Rs.)?

17. Do you have a warehouse or distribution center? *

Yes

18. What benefits do you expect as an ACL Agent/Dealer ? *

Access to a wide portfolio of polymers

Competitive pricing

Attractive rebates/discounts/ commission based on sales performance.

Technical support

Early access to price changes

Polymer Trends/News

19. Briefly describe your company special capabilities, which stands out from competition. *

20. How soon you intend to start as ACL Agent/Dealer ? *

21. Upload GST Certificate (PDF) *

Upload your gst certificate in PDF/Image format (max 2MB)

22. Upload PAN (Image or PDF) *

Upload your PAN (max 2MB)