Kwik e Mart - Retailer Signup

Personal Information

First Name

Last Name

Email Address

Phone Number

Profile Image

Password

Address Information

Street Address

Building/Apartment

City

Postal Code

Store Information

Store Name

Store Mobile

Description

Store Email

Time Zone

Opening Time

Closing Time

Store Logo

Banner Image (Img size 374 x 200)

Store Location

Zip Code

Latitude

Longitude

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