dealers booth application form

APPLICATION FORM FOR DEALER’S BOOTH

For KERAPEX-2016

Name
Designation
Business Name
Address
Contact No.:
Email id:
No.of booths required:
Amount of Rs.10000/- remitted vide (tick and fill the appropriate)	1) DD dated ………… drawn on ………..…… bank, in favour of ‘The Kerapex-2016 Secretariat’  2) NEFT transfer dated …………. to Union Bank account No.522802010007188, IFSC Code:UBIN0552283 from ………….. bank account no. ………………. ……. (once online payment has been made, please email us your name , address , mobile number and NEFT reference details to kerapex2016@gmail.com )

        I have read and understood the special rules of the exhibition and shall abide by them.

Signature:

Date:

Place: