Dealer / Recharge Sales Registration Form
Name :    Age :   
Language : :    NIC No. / Driving / Riding Licence :  
Current Occupation :    Place of Work : :   
Dealership in which city/town :    District :   
Proposed Business Location :   
Tel. / Office :    Mobile :   
Interested in :    Dealership Recharge Sales Both               Are you a existing Dealer for any company Yes No
If yes, please specify company names :   
Current number of employees :    Shop Open Timings :   
Do you sell Mobile Connections :   Yes No
If yes, please specify operators :    Average connections per month :   
Do you sell Mobile Recharge Coupon :   Yes No Average monthly sale value :   
If yes, please specify operators :   
Remarks (any other information which is releted to DTH & Dish TV)