Delvalley Silver Inc.

Merchant Form

Merchant Id	Merchant ID will assign after Joining
Password
Retype Password

Referral ID

Gender

Male Female

First Name

Last Name

Date of Birth

Business Information

Business Name
E-mail ID	(* If Member is Merchant then use different mail id)
Merchant's URL	http:// Please do not include " http:// " before any web address
	write only www.example.com
Business Category	Add New Category (Press Ctrl to select Multiple Category)
Address 1
Address 2
City
State
Zip Code

Contact Information

Phone:

Cell:

Fax:

Merchant's Offerings:

Additional Information:

I have read and agree to DelValley Merchant Terms and Conditions.

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