Model Registration

Username*

Username*

Email*

Email*

First Name

First Name

Last Name

Last Name

Store Name*

Store Name*

https://enter.lollipops.co.za/lollipops/[your_store]

Address 1*

Address 1*

Address 2

Address 2

Country*

Country*-Select a location-South Africa

City/Town

City/Town

State/County

State/County

Postcode/Zip*

Postcode/Zip*

IDENTITY NUMBER OR PASSPORT NUMBER*

IDENTITY NUMBER OR PASSPORT NUMBER*

I consent to and agree with the websites Terms And Conditions*

I consent to and agree with the websites Terms And Conditions*

I Declare That I am Over The Age Of 18*

I Declare That I am Over The Age Of 18*

Password*

Password*

Confirm Password*

Confirm Password*

* Agree  Terms & Conditions