Become a Partner

First Name:*

Last Name:*

Contact Person:*

Designation/Title/Position:*

Company Name:*

Address Information:*

Country:*

Phone:*

Mobile:*

Email: *

Fax:

You want to become a partner as:*

Distributer Agent

For which Area/State/City are you planning to take up an Distribution?*

TDo you sale any other products, If yes, which are they?(choose one or more )*

The expected number of units distributed per month*

Do you sell other products in the the previous?*

Yes No

Do you want your name to appear on corporate and product website?*

Yes No

We clearly state that I/ We are interested to take up offer as anDistributor of Petra Software Ind's. *

We state, that the above information provided here is true the best of my/our knowledge *