| Username: |
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| Full Name: |
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| Email: |
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Please provide an active email address to facilitate future payment related correspondences. (25 chars) |
| Password: |
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Between 6 to 12 alphanumeric (A-Z, a-z, 0-9) character only. |
| Confirm Password: |
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| Contact Number: |
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Please provide a valid contact number (numbers only) for future promotion and payment correspondences. |
| Verification Code: |
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