Username*
Email*
First Name
Last Name
Store Name*
https://sucex.com.ng/store/[your_store]
Address 1*
Address 2
Country*
City/Town
State/County
Postcode/Zip*
Store Phone*
Date of Birth*
Business/Company Name*
Business Address*
Address Closest Landmark*
Business Description*
Passport Photograph*
Password*
Confirm Password*
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