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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