Kansas Antique Network :: Vendor Registration

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(1) Vendor Signup
(2) Business Information

Please enter your personal information below, this is to ensure that you can access the site properly and to help us contact you if you require assistance.

Username*
Username already taken or is less than 5 characters long.

This field is required.
Email Address*
Email address already in use or not valid.

This field is required.
Confirm Email Address*
Both Email addresses entered do not match.

This field is required.
Password*
Must be at least 5 characters long.

This field is required.
Confirm Password*
Both passwords do not match.

This field is required.
Zip Code*
Not a valid zip code.

This field is required.

First Name*
This field is required.
Last Name*
This field is required.
Gender*Male Female
This field is required.
Cell Number*
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)

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This field is required.
Cell Carrier*
This field is required.
Referrer
I would like to occasionally recieve sms coupon offers from Kansas Antique Network to my mobile. Note: The recipient of this text message may incur charges depending on your wireless carrier. No pre-paid phones are supported.
I agree to the site's privacy policy and terms and conditions.
You must agree to the site's terms and conditions.

Please enter your business information below, note that the location below is your main premises, you can add other locations when your account has been created.

Business Name*
Business name already taken or field is empty.

This field is required.
Business Category*
This field is required.
Business Description* (a short summary of what your business does.)
This field is required.

Below please enter the address of your main premises, this can be changed once you are signed up if required.
Address*
This field is required.
Neighborhood/ Region*
This field is required.
City*
This field is required.
State*
This field is required.
Zip Code*
Not a valid zip code.

This field is required.

Website
Phone Number
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Finally please enter some comma-seperated tags for your business, i.e. if it were a pizza company it could be something like 'pizza, free delivery, pepperoni, fresh, deep pan' etc. This enables visitors to find your business more easily.
Tags

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