Username*
Email*
First Name
Last Name
Store Name*
https://crypto-pros.ca/store/[your_store]
Address 1*
Address 2
Country*
City/Town
State/County
Postcode/Zip*
Store Phone*
ID Verification (Photo of you on ID or with ID)*
Date of Birth*
Upload your recent Proof of Address (within 90 days)*
Extra Details you might want to share with US.
Password*
Confirm Password*
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