* 1. What is your name?

* 2. What is your street address? (include City, State, Country, Zipcode)

* 3. What is your email?

* 4. Do you have a separate Paypal email?

* 5. I am A?

* 6. Business Name?

* 7. What is your business website, mobile app, personal website, or social handle (Instagram or Twitter)?

* 8. How did you hear about Quidd?

* 9. What channel(s) will you be representing?

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