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*Required fields

• First Name*
• Last Name*

  Suffix
• Birthdate*
• Gender* Select Male Female

• Are you the Store owner?*
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• What JTI brands do you sell?*
  Camel

  Marvel

  Winston

  Mighty

  Mevius

• Email address (optional)
• Username*
• Password*
• Confirm password*
• Security Question* Select What was your childhood nickname? In what city did you meet your spouse/significant other? What is the name of your favourite childhood friend? What street did you live on in third grade? What was the name of your elementary/primary school? What is the name of the company of your first job?
• Answer*