Mitra Industries

Be Our Channel Partner

Dealership Application

Partner with Mitra to distribute reliable medical technologies across transfusion medicine, peritoneal dialysis, and interventional therapies. Tell us about your business and we'll be in touch.

Dealership Application Form

Complete the form below to apply to become a Mitra channel partner. Fields marked with an asterisk are required; mark documents as “Not applicable” where they don’t apply.

01

Dealership Interest

02

Company Details

03

Contact Details

04

Business Profile

Current Business Areas
Key Customer Segments
05

Documents

Company Registration Document
GST Certificate
Drug Licence or Relevant Licence
Company Profile
06

Declaration