Customer sign up form

*First name:

Your first name

*Last name:

Your last name

*Email:

An email you use

*Telephone number:

A Cameroonian telephone number with the country code prefix, e.g., +237670000001

*Region:

--------- FAR-NORTH NORTH ADAMAWA CENTER LITTORAL NORTH-WEST WEST SOUTH-WEST EAST SOUTH

In which region are you?

*City:

--------- Abong-Mbang Ako Akonolinga Ambam Amchide Bafang Bafia Bafoussam Bafut Bali Bambili Bamenda Bandjoun Bangem Banyo Batibo Batouri Bertoua Buea Bélabo Campo Dimako Dizangue Djoum Douala Dschang Ebolowa Edéa Eyumojock Fontem Foumban Foumbot Fundong Garoua Garoua-Boulaï Guider Idenau Kaélé Kousséri Kribi Kumba Kumbo Limbé Lomié Loum Makénéné Mamfe Manjo Maroua Martap Mbalmayo Mbandjock Mbanga Mbankomo Mbengwi Mbouda Mbê Meiganga Melong Menji Mfoundi Mokolo Monatélé Mora Mouloudou Mutengene Muyuka Nanga Eboko Ndop Ndu Ngaoundéré Nkambe Nkongsamba Nkoteng Nkwen Obala Penja Sa'a Sangmélima Santa Soa Tibati Tiko Wouri Wum Yabassi Yagoua Yaoundé Yokadouma

In which city are you?

Neighborhood:

In which neighborhood are you?

*Password:

• 12 characters minimum
• at least 1 uppercase letter
• at least 1 lowercase letter
• at least 1 number
• at least 1 symbol e.g., @, #, _ etc.

*Confirm password: