Customer Profile
STORE DETAILS
This section is for the store/outlet details
STORE NAME *
Please provide a valid Shop Name.
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ACTIVITY *
Please provide a valid Shop Activity.
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STORE PHONE(S) *
Please provide a valid Shop Phone.
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REGION *
Please provide a valid Shop Region.
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PHYSICAL ADDRESS *
Please provide a valid Shop Address.
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STORE EMAIL *
Please provide a valid Shop Email. Example: example@host.com
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OWNER FULL NAME *
Please provide a valid Owner Name.
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OWNER MOBILE *
Please provide a valid Owner Mobile Number.
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OWNER EMAIL *
Please provide a valid Owner Email. Example: example@host.com
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MANAGER NAME *
Please provide a valid Manager's Name.
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MANAGER MOBILE
MANAGER EMAIL
ASSISTANT MANAGER
ASSISTANT MOBILE
ASSISTANT EMAIL
COMPANY DETAILS
This section is for the company details
Are you a registered company?
OFFICE FULL ADDRESS *
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REGION *
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OFFICE EMAIL *
Please provide a valid Company Email. Example: example@host.com
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OFFICE PHONE *
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FOR AND ON BEHALF OF THE COMPANY
YOUR NAME *
Please provide a valid Full Name
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POSITION *
Please provide a valid position
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MOBILE *
Please provide a valid creator's Phone
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Documents
This section is for the store/outlet documents
COMPANY LOGO
COMPANY DOCUMENTS
To digitally sign the document, click the yellow signature icon located within the document. To proceed with signing, you acknowledge that the following digital representation of your signature is legally binding for this document.
Please provide your new digital signature representation.

Signature:
*
Please sign the profile by clicking the yellow pen icon, if you accepted your signature please reclick the yellow pen icon to confirm
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Log file