1. CONTACT INFORMATION

1.5. What is your company position? *

2. BUSINESS DETAILS

Address *

2.3. Business Address

2.4. City

2.5. Province / State

2.6. Country

2.7. Postal Code

2.8. What best describes your business? *

2.9. What products or services do you offer?

Type your answer in the space provided.

2.10. Do you currently sell your products or services? *

3. BUSINESS REGISTRATION & VERIFICATION

3.1. Google Drive: Business Registration & Verification Documents *

Please upload your applicable business verification documents to a Google Drive folder and paste the folder link below. Ensure that Longevity108 has permission to view the files.

I confirm that the information provided is accurate and that I am authorized to submit this application on behalf of the business or professional practice identified above.

I have read and agree to the Longevity108 Seller & Service Provider Registration Terms and Conditions