Registration Form – Peru Minerals Store

Please, in order to get special Wholesale prices, fill this Registration form.

Registration

Username*

Email*

Password*

Customer billing address

First Name *

Last Name *

Company *

Address line 1 *

Address line 2 *

City*

Postcode / ZIP *

Select billing country (optional)

State / County or state code *

Phone *

Customer shipping address

Copy from billing address

First Name *

Last Name *

Company *

Address line 1 *

Address line 2 *

City *

Postcode / ZIP *

Select shipping country (optional)

State / County *

Tax ID

File Upload

We’ll send you a confirmation email that your Account is suitable for Wholesale.

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