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Email*
First Name
Last Name
Store Name*
http://www.jombazzar.my/Jombazzar/store-detail/[your_store]
Address 1*
Address 2
Country*
City/Town
State/County
Postcode/Zip*
Store Phone*
ICNumber*
IC Front*
IC Back*
Legal Name / Company Name
Business Registration Number
SSM Cert
Bank Account Name*
Bank Account Number*
Bank Name*
Bank Code*
Branch Name*
Privacy Policy*
Password*
Confirm Password*
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