Request for KHQR Form Shop Information Shop Name* Business Activity* Shop Contact Number* Shop Full Address* Province/City* -Province/Capital- Branch* -Select Branch- Payment Facilitative POS Machine KHQR Standee KHQR Sticker Lanyard Bill Holder Account Information Have you already had KB PRASAC account? YesNo Account Number USD Account Number KHR Contact Information Contact Full Name Contact Position Contact Phone Number Attach Document