Thanks for choosing ELC UK LTD

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(All * fields are mandatory)

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Shop Name *

Name of Owner *

First

Last

Delivery Address *

Address Line 1

City

State / Province / Region

Postal Code

This address is your shop's address where we can deliver your order to.

Home Address *

Address Line 1

City

State / Province / Region

Postal Code

We use this address for verification purposes.

Contact Person *

First

Last

Mobile Number *

To contact the owner.

Telephone Number *

This could be for your shop.

Email Address *

Email

Confirm Email

Number of Years Established

Selected Value: 0

Delivery Instructions

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Opening Time *

For delivery purposes.

Closing Time *

For delivery purposes.

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Account Type: Please select appropriate box

• Pizza Shop
• Chicken Shop
• Fish & Chip Shop
• Restaurant
• Sandwich / Baguette Shop
• Cake Shop
• Super Market

Upload ID Card *

Click or drag a file to this area to upload.

For account verification and activation purposes.

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Name of Referrer or Salesman

Reference Name (If any)

Submit