Retailer Registration

Join DirectMitra and Grow Your Retail Business

1. Personal & Store Information

Full Name *

Store / Shop Name *

Shop Type *

Year Established

GST Number (If any)

PAN Number *

Date of Birth *

Mobile Number *

Alternate Mobile Number

Email Address *

Landline Number (If any)

WhatsApp Number

Address Line 1 *

Address Line 2

City *

State *

Pincode *

Country *

Products You Deal In *

Average Monthly Purchase (₹)

Number of Employees

Business Description

Bank Name *

Account Holder Name *

Account Number *

IFSC Code *

Shop / Store Photo *

GST Certificate (If any)

PAN Card *

Address Proof *

Cancelled Cheque *

ID Proof *

Username *

Password *

Confirm Password *

I hereby declare that all information provided is true and correct.

Your information is secure and will not be shared with any third party.