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Online Store Registration Form
Account Information
fields marked * must be filled
Username*
Email*
The information below is optional but required for delivery !
First Name
(Required for delivery)
Last Name
(Required for delivery)
GSM No. (e.g. 0XXXXXXXXXX)
State
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
location
Barnawa
Kawo
not specified
Goningora
Kabala
Kachia Road
kaduna Town
Kakuri
Kamazo
Malali
Mando
Narayi
Nasfat Village
Sabo Tasha
Ungwar Boro
Ungwar Dosa
Ungwar Rimi
Ungwar Romi
Address
Site Password Information !
Password*
*Password should not be similar to Username
*Password must contain at least 8 Characters
*Password must contain at least a letter or digit
Confirm*
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