| Dealer Fill-in Section | |||||||||
| Merchant Registration Name | Chinese: | English: | Organization Code* | ||||||
| Business License Number | Nature of Business | □ Limited Liability System □ Joint Stock System □ Private Non-Enterprise □ Individual Business □ Other (please specify) | |||||||
| Dealer Responsible Person | Document Type | □ ID Card □ Passport □ Other | Document Number | ||||||
| Store Information | Registered Name | Same Merchant: □ Yes □ No (Please specify separately) | Yes | ||||||
| Business License Number | No | ||||||||
| Business Name | Same Store Registered Name: □ Yes □ No (please specify) No | ||||||||
| Business Scope | |||||||||
| Business Address | Province City (District) Street (Town) Neighborhood Committee (Village) Number | Postal Code | |||||||
| Opening Date | Year Month Day | Business Hours | : (a.m.)— : (p.m.) | Business Area | M2 | ||||
| Number of Employees | About People | Number of Business Floors | Floors | Average Monthly Revenue Ten Thousand | About Ten Thousand Yuan | ||||
| Store Responsible Person | Position | Boss | Contact Number (Landline: Mobile: ) | ||||||
| Daily Contact Person | Same Store Responsible Person □ Yes □ No (please specify) Same Store | Name | Position | Contact Number | |||||
| Fax | |||||||||
| Settlement Information | Account Name | Clearing Account Number | |||||||
| Bank Name | Bank City | Bank Contact Number | |||||||
| Send Withdrawal Details | Financial Contact Person | Contact Number | |||||||
| Merchant Signature | Date | Seal | |||||||
| Our company's dedicated column | ||||||||||
| Name of investment specialist | Salesperson code | Tel | Mobile | |||||||
| Promotion method | □ Merchant actively applies □ Actively contact merchants | On-site visit | □ Yes □ No | Verify original documents | □ Business license □ Organizational Chart code certificate Tax proof documents | |||||
| Promotion notes | Registered capital | Ten thousand yuan | Merchant establishment date | Year Month Day | Merchant registered address | |||||
| Business environment | □ Central business district □ Suburban business district □ Residential small business circle □ Residential area □ Office area □ Industrial area □ Other (please specify) | |||||||||
| Store nature | □ Street independent store □ Large shopping mall sales area □ Professional square shop space □ Office building □ Sales counter □ Other (please specify) | |||||||||
| Sales method | □ Wholesale □ Retail □ Both wholesale and retail □ Other | Operating channels | □ Store □ Internet □ Phone/Fax □ Other | |||||||
| Return policy | □ Non-returnable □ Returnable (specific policy: ) | |||||||||
| Assessor's name | Assessor's code | Assessment method | □ Phone □ Internet □ On-site □ Other | |||||||
| Assessment notes | Signature: Date: | |||||||||
| Person in charge | Signature: Date: | |||||||||
| Special application | Applicant: Date: Year Month Day Authorized signatory: Date: | |||||||||
 
               
             
                         
