Registration

Membership Checkout

Membership Information

You have selected the MERCHANT membership level.

If you want to sell goods and services to members of our community, at a discounted rate.

The price for membership is $0.00 now.

Account Information

Username

Password

Confirm Password

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

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Merchant – More Information

First name

Last name

Business Name

Business Registration Number

Business Address

Type of Business

(e.g., sole proprietorship, partnership, corporation)

Tax Identification Number (TIN) or Employer Identification Number (EIN)

Contact Phone Number

Website or Online Store URL

Description of Products/Services Offered

Business Bank Account Details

Primary Business Bank Name and Address

Nature of Business Transactions (e.g., B2B, B2C)

Average Transaction Value

Any Additional Information or Documents Required for Verification

Declaration of Compliance with Lead54’s Terms and Conditions

Billing Address

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Payment Information

Card Number

Expiration Date

Security Code (CVC)

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