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APPLICATION FORM FOR DISTRIBUTORS
 
NAME OF APPLICANT*
FATHER NAME
NIC.No.*
RESIDENTIAL ADDRESS *
PHONE No.*
MOBILE NO
DISTRIBUTION PROVINCE FOR AREA
REQUIREMENT OF CYLINDER Commercial Cylinder (45.4 Kg)
 Medium Commercial Cylinder (15 Kg)
Domestic Cylinder (11.8 Kg)
Medium Domestic Cylinder (6 Kg)
CITY
PROVINCE
BUSINESS ADDRESS
E-MAIL
FAX
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