Email*

Email*

First Name

First Name

Last Name

Last Name

Store Name*

Store Name*

https://victorianstar.com/shop/[your_store]

Store Phone*

Store Phone*

Primary Contact Person Name*

Primary Contact Person Name*

Company/Business Name (As registered on URSB)*

Company/Business Name (As registered on URSB)*

Tax Identification Number(TIN)

Tax Identification Number(TIN)

Company/business Registration Number

Company/business Registration Number

Password*

Password*

Confirm Password*

Confirm Password*

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