REQUISITION FORM [ to be filled by the Customer / Representative ] Date:_________ Name of the Industry : District & Off-take Book No : Bank A/c No. : S. No DD /Cheque No Date Name of the Bank Place of Issue Amount 1 2 3 C / D form No. :1]__________________2]__________________3]__________________ Customer / Authorised || ____________________ ________________________ Representative || Name Signature [ for OFFICIAL USE ] File No. :_____________ Customer Code No. :____________ Month :_________Quota/Eligibility :________ S.No. Quantity to be issued Grade Despatch point Code 1 2 3 Credit / Debit : 1]__________________ 2]__________________ 3]__________________ Add1.Mgr[Sales] Remarks:
