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PERSONAL DETAILS
Surname
First Name
Date of Birth
Email address
Sex
Male
Female
Phone Number
Home Address
Nearest Bus Stop
State
ABIA
ABUJA
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
ZAMFARA
LGA
Country
BUSINESS DETAILS
Shop Address
Landmark
Nearest Bus Stop
LGA
State
ABIA
ABUJA
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
ZAMFARA
Country
Bank Account Name
Account Number
Bank Name
Account Type
Total Number of Cashiers
Referral
Upload ID Card
Upload Passport Photograph
Upload Shop picture (inside)
Upload Shop picture (outside)
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