AGENT REGISTRATION FORM
PERSONAL INFORMATION
First Name
Last Name
Address
City
State
Zip Code
Country
United States Of America
Phone
Occupation
Date of Birth
Marital Status
--- Select option ---
Single
Married
Divorced
Gender
--- Select option ---
Male
Female
ACCOUNT INFORMATION
Username
Password
Email
Your account is currently not activated because you have not paid your Account Opening / Activation Fee of $1500. You will not be able to Transfer funds or pay bill online. If you have already paid and obtained your Account Activation Number (AAN), please select "I have paid for activation" below and enter your Account Activation number. Otherwise select "I want to pay for activation" to proceed with the payment.