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Vendor Application
MRecord strongly believes that having the right medical transcription service provider as a partner is the key 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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