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Vendor Application

We have currently stopped accepting any new Vendor Partner Application. You may apply using the form below and as and when new spots become available our team will contact you.
Please do not contact us via phone, email or chat on our website as we are unable to entertain application requests outside of this site. We will contact you as our needs expand.
 
MRecord strongly believes that having the right medical transcription service provider as a partner is the key to customer satisfaction and growth in this industry.

If you are a quality-driven service provider who is exploring the possibility of a new partnership with MRecord, please complete and submit the following vendor-partner form.
* required fields with asterisk
Company Information  
Legal Name of Company :  *
Type of Company :  *
Company's contact Information  
Business Ownership :  *
Registered Address :  *
 
City :   *
State :   *
Zip :   *
Country :  *
Business Phone :  *
Website :  
Year Established :  *
Primary contact Information  
Contact Person :  *
Business Phone :  *
Mobile Phone :  *
E-Mail :   *
Billing contact Information  
Contact Person :  *
Business Phone :  *
Mobile Phone :  *
E-Mail :   *
Infrastructure & IT Systems  
No of Seats :  
Physical Securities :

 *		  
IT Securities :


 *		  
Production Capacity Details  
Current Production Capacity :  *
Current Spare Capacity :  *
Current Staff Details  
MT :  *
QA :  *
Auditor :  *
Basic Configuration of PCs  
Processor :  *
RAM :  *
OS :  *
Internet Connection  
Primary Connection :  *
Speed :  *
Backup connection:  *
Power Backup  (per PC):  *
Additional Security Measures [describe in detail]  
   
Create an Account (Required)  
Please provide valid E-mail address, as it will be used for all future correspondence from us.
E-Mail :  *
  Please enter a STRONG password which is at least 6 characters long. A STRONG password includes at least 1 alphabet, 1 number & 1 symbol character  
Password :  *
 
Weak Strong
 
Confirm Password :  *
 

 
   
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