ShopX - Grocery Delivery

Personal Information

First Name*

Last Name*

Email Address*

Phone Number*

Password*

Confirm Password*

Address

City

State

Zip Code

License Number*

License State*

Vehicle Make*

Vehicle Model*

Vehicle Year*

Vehicle Color

License Plate*

Delivery Experience

References

Weekdays (Monday-Friday, 9am-5pm)

Weeknights (Monday-Friday, 5pm-10pm)

Weekends (Saturday-Sunday)

Full-time Availability

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