Fullname

Merchant Name

Email

Customer Service (CS) Phone Number || Must Have WA Account

Password

Confirm Password

Association Type UMKM PARIWISATA

Merchant Address

Merchant Description

City Choose City Barito Selatan Barito Timur Barito Utara Gunung Mas Kapuas Katingan Kotawaringin Barat Kotawaringin Timur Lamandau Murung Raya Pulang Pisau Sukamara Seruyan Palangka Raya

District Choose District