Sadly this isn’t possible.
This form is created & hosted on our site’s servers, and is currently serving all of Wholesale Gorilla’s clients - you may have noticed that the URL is a bit different from the rest of the site; this is called a proxy, and let’s our server inject this form onto your site so that the auto-approval & auto-tag features can function. Due to the fact that this form serves all clients, it must be kept as generic as possible.
If you find that this form’s required information is inadequate, we recommend creating a secondary form somewhere else on your site and leaving a note in the signup page messaging area with steps on how to find this new form. If you feel that this secondary form is 100% crucial for a customer to earn an account, simply turn off auto-approval and only approve the accounts once they’ve filled out both forms. We do not create or provide these secondary forms.