Micro dealer application

• Real Name*
• ID number *
• Sex *
  Man

  Woman
• Birthday *
• mobile phone *
  
  
• Fixed number *
• Contact Email *
• QQ number *
• WeChat number *
• bank of deposit *
• Bank card number *
• Payee name *
• Contact address *
• Name of shop or company
• Store or company address
• Store or company URL