TAMILNADU CONSUMER PRODUCTS STOCKISTS ASSOCIATION
(Chennai Unit Reg.No.270/92)
#2/3 , 4th Street, Judge Colony, Sanatorium,
Chennai-600047. Phone: 9884063063
www.tncpsa.in
Date:
Membership Application Form
To: Passport Size
The Hon.General Secretary Photograph
Dear Sir,
Kindly find enclosed my application for New Free Membership in your
Association, which is duly filled
Yours truly,
Signature of Applicant
With Firm Rubber Stamp
DETAILS
1. Agency Name & Postal :
Address (in BLOCK letters)
Pin Code:
2. Constitution of Agency : Proprietor / Proprietrix / Partnership / Pvt.Ltd.
With Details
3.Distributors for & Areas :
covered
4.Names of Sister Concerns :
(if any)
5.Contact Person Name and
Phone Numbers :
Name :
Office :
Res. Ph. :
Mobile :
Fax :
E-mail :
Application accepted subject to approval by the Executive Committee.
Fill-up separate form for sister concerns if any.