Grow with Shopzop – Distributor Registration Form

Full Name

Email Address

Business / Shop Name

Business Role / I am a… - Select - Shop Owner Market Influencer Sales Agent Distributor / Sub-Distributor Local Business Partner Community Leader Other

City / Town

State - Select state -

Zipcode/Pincode

Local Area / Market Name

District

Approx. Network Size - Select - 1–5 retailers 5–15 retailers 15–30 retailers 30–50 retailers 50+ retailers

Type of Retailers in Your Network - Select - Electronic retailers Mobile shops General stores Appliance stores Fashion/garments shops Accessories shops Other

Your Approx Monthly Purchase Capacity - Select - Below ₹50,000 ₹50,000 – ₹2,00,000 ₹2,00,000 – ₹5,00,000 Above ₹5,00,000

Shopzop Staff ID (non-mandatory)

DishTV/D2H Distributor ID (for existing distributors)

Tell us a bit about your business or requirement

I agree to be contacted by the Shopzop team regarding the Distributor program.