Username*

Email*

First Name

Last Name

Store Name*

https://bgenz.com/Bio/vendor/[your_store]

Address 1*

Address 2

Country*

City/Town

State/County

Postcode/Zip*

Store Phone*

Phone Number*

About your Store*

Bank Account Details / Bank Name*

Beneficiary Name*

Account Number*

Swift code*

Upload Commercial ID Card*

Upload Tax ID Card*

Upload Commercial Agency agreement*

Password*

Confirm Password*

* Agree  Terms & Conditions