Libra - Merchant Portal

1. Merchant Information

Business Registration Number*Business Registration Number*

Business Registration Name*Business Registration Name*

Tax CodeTax Code

Issue Date*Issue Date

Select issue date

WebsiteWebsite

2. Address Information

Province*Province*

Select province

Ward*Ward*

Select ward

Address*Address*

3. Contact Information

Contact Phone Number*Contact Phone Number*

Contact Email Address*Contact Email Address*

Business Information