Business Information
Tell us about your wholesale distribution business.
Business name is required
Address is required
City is required
State is required
Owner Details
We need to verify the owner of the business.
Owner name is required
Valid 10-digit mobile required
Valid email is required
Licences & Registration
These details are mandatory for drug trade verification.
Drug license number is required
Wholesale drug license issued by state licensing authority
Valid 15-digit GSTIN required
Valid PAN required
Bank & Payment Details
Used for billing reconciliation and payments. All information is kept confidential.
Bank name is required
Account number is required
IFSC code is required
Review & Submit
Please review your information before submitting.
⚠️ By submitting, you confirm that all information provided is accurate. False information may result in rejection or account suspension.
Registration Submitted!
Thank you for registering with MediVision AI. Our team will verify your drug license and GSTIN and contact you within 24 hours with your login credentials.
What happens next?
- Our team verifies your drug license & GSTIN
- We call you on to confirm identity
- Login credentials are sent via SMS
- You can start using the platform immediately