Email*

Email*

First Name

First Name

Last Name

Last Name

Store Name*

Store Name*

https://easternlady.com/store/[your_store]

Store Phone*

Store Phone*

pickup Address (full)*

pickup Address (full)*

CNIC Number*

CNIC Number*

preferred Payment Method*

preferred Payment Method*Bank Transfer Jazzcash EasyPaisa

Account Number & Title*

Account Number & Title*

Password*

Password*

Confirm Password*

Confirm Password*