APPLICATION FOR INDUSTRIAL ASSOCIATE MEMBERSHIP

To

    The Dean, 
    PSG Centre for Sponsored Research & Consultancy
    PSG College of Technology
    Peelamedu P.O.,
    Coimbatore - 641004

1.Name of Industry : 

2.Address : 

3.PIN :

4.Telephone / Fax No : 

5.Contact Persons with Designation : 
 

6 Major area of activity : 

7.Products manufactured Details Enclosed :

8.Number of Library cards required :

9.Names of persons authorised to use the Library 

1.

2. 

 We are a SMALL / MEDIUM / LARGE Scale Industry. 

Demand Draft No. …………… dated…………………. For Rs. …………….… drawn on ………….…………………….

In favour of  "PSG College of Technology" payable at Coimbatore is enclosed.

Signature   :

NAME        :

DESIGNATION :

Date : 

Encl: Copy of Certificate of registration of the Industry.