Retailer Registration
Retailer Name *
Firm Name
Address *
Mobile *
Block:
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Baitalpur
Bankata
Barhaj
Bhagalpur
Bhaluwani
Bhatni
Bhatparrani
Deoria Sadar
Desahi Deoria
Gauri Bazar
Lar
Pathardeva
Rampur Karkhana
Rudrapur
Salempur
Tarkulwa
Date of Birth *
Profile Photo *
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