Distributer

Name of Company

Address

How long have you been operating?

Number of branches (if any)

How long have you been in juice and allied product trading?

If yes, kindly state the product(s)

Monthly Turnover

How much are you ready to invest in this business?

Do you have financing arrangement with any financial Institution?

Average monthly turnover for the part six months

Do you have owned vehicle for distribution?

If yes, state the name. If no, state your plans

Name

Address

Phone

Name

Address

Phone

Name

Address

Phone

Bank Name

Address

How long has the account been operating?

Do you enjoy any facilities?

Name of First reference

Address

Occupation

Name of Second reference

Address

Occupation

What is the minimum in carton that you envisage per month

IMPORTANT: what area do you intend to cover as a distributor / sub distributor

What areas do your wholesaler / sub distributor / customers cover?

NAME OF OFFICER / INSTITUTION DISTRIBUTOR COMPLETING THIS APPLICATION

Address

Position

Phone

Date