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First Name

Last Name

Phone Number(Work)

Contact Number

(Account verification code will be sent to this number)

Account Type

Company Name

Address (House No., Street, City, State and Country)

Zip Code

License Number

Business License File ( Type : jpg | jpeg | png | pdf | doc | docx )

Note - The address and the name should match the license documentation.

First Name

Last Name

Phone Number (Work)

Contact Number

(Account verification code will be sent to this number)

Company Name

Address (House No., Street, City, State and Country)

Zip Code

Please put a check mark in this box to indicate that your company is insured and provide the information of the insurance company.

Insurance Company Name

Contact person Name

Company Contact Number

Insurance Validity and Expiration Date

Site Url ( include http:// or https:// )

Insurance Doc ( Type : jpg | jpeg | png | pdf | doc | docx )

Password

Confirm Password

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