Distributor Registration

First Name

Please enter your first name (letters only).

Last Name

Please enter your last name (letters only).

Please enter a valid email address.

Username

Username must be at least 3 characters (letters, numbers, underscore).

Phone Number

Please enter a valid 10-digit phone number.

Password

Password must be at least 8 characters with uppercase, lowercase, number, and special character.

Confirm Password

Passwords do not match.

Attach Document

Accepted formats: PDF, DOC, DOCX, JPG, PNG (Max 5MB)

File must be PDF, DOC, DOCX, JPG, or PNG and less than 5MB.