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                  |  * 
                      User name:  | (4-32 characters) |   
                  | * 
                      Email address: |  |   
                  | * 
                      First name: |  |   
                  | * 
                      Last (family) name: |  |   
                  |  
                      Address: |  |   
                  |  
                      City: |  |   
                  |  
                      ZIP: |  |   
                  |  
                      Country: |  |   
                  |  
                      State or province: |  |   
                  |   
                      Phone number: | (International form, e.g. +233202699110) |   
                  |  * 
                      Cell number: | (International form, e.g. +233202699110) |   
                  |  
                      VAT ID: |  |   
                  | Initial prepaid service: |  |  * 
                Fields are mandatory!  
                
               
  
                
                
                
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