Register
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Cooperative Registration
ProbityCoop Enterprise
Cooperative Information
* Cooperative Name:
The name of the cooperative
* Cooperative Number:
Cooperative registration number
* Cooperative Address:
Cooperative location/office address
* Preffered Username:
Cooperative Url ( eg. probitycoop)
* Number of Members
Select Range
0-50
51-300
300-above
Current number of members in the cooperative
Cooperative Logo:
Chose Image
Maximum Image size: 100kb
Dimension: 200 x 200 (kb)
*Referrer Super Agent
Select Super Agent
ProbityCoop
Probity
FCMB
Agent Information
Full Name:
Please enter your agent full name
Email Address:
Please enter your agent email
Phone Number
Please enter your agent phone
Address:
Please enter your agent address
* Select Role
Select Role
President
Treasurer
Secretary
Gender:
Male:
Female:
Submit
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