Thanks for choosing ELC UK LTD

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*Subject to delivery route availability.

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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

Mobile Number

To contact the owner.

Telephone Number

This could be for your shop.

Email Address

Confirm Email

Number of Years Established

Selected Value: 0

Delivery Instructions

Opening Time

For delivery purposes.

Closing Time

For delivery purposes.

Upload ID Card

Click or drag a file to this area to upload.

Driving license for example. For account verification and activation purposes.

Name of Referrer or Salesman

Reference Name (If any)

Checkboxes

I confirm! *

I confirm that the information I have given is correct and I am happy to be contacted with regard to my account, orders, payments, deliveries, and any offers via WhatsApp, phone or Email.
I also understand that payment is to be made at the time of ordering.