Co-operative registration -

Cooperative

Please fill-out this form

User name

Password

Select Status Affiliate Group

Email Address Account

Mobile / Phone Number

Name of Group

Registration Number

Cooperative Complete Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Objective of Group

Area of operation

Some description about your Co-operative

How do you intend to promote MITACOR Marketplace Products? (Articles, PPC, Email, Social Media, YouTube, etc.):

Certificate of Registration (File type allowed "PDF, doc, jpg / Maximum 2 file / file size limit 2mb")

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