Register Retailer / Merchant


Business Name *
Full Name *
Mobile Number *
State *
District *
Full Address1 *
Full Address2 *
Phone Number *
Email *
PAN Number *
Bank Account Name *
Account Type *
Bank Account Number *
Branch Name *
Bank Name *
IFSC Code *
Legal Business Name *
Company Market Name *
Shop Registration Date *
GstNumber
Distributor Email

Upload Adhar (both Side) / PAN / Bank Proof *(1 MB Maximum Size)

Upload Adhar (both Side) *
Upload PAN *
Upload Bank Proof (canceled cheque / Passbook Copy) *