Name of Customer

Contact No

Referred by
SelectOwnTaj employeeExisting Taj Dealer

Name

Contact No

Email

A. Total Area of Plot in sq ft

B. City/ District (drop
down options)

C: Address

D: GPS location

Site/station
type
Petrol PumpCNG pump

Current OMC

Current Sales (PMG, HSD,
Hi Octane, Lubricant)

Total Area of Plot
in sq ft

City/ District

CitiesKarachiLahoreIslamabadQuetta

GPS Location

3 What other business is the dealer Involved in? : (Optional)

4 Why do you wish to work with TGPL? : (Optional)

5 Additional Information/ Comments : (Optional)