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CUSTOMER REGISTRATION
Fields marked with an asterisk * are required

ACCOUNT INFORMATION
*ID
*Password
*Confirm Password
Following question will be asked if you forget your password
*Secret Question
*Secret Answer

BASIC IDENTIFICATION AND COMMUNICATIONS INFORMATION:
*Customer Name
*Mailing Address
*Street Address
*City		*State/Region
*Country		Zip (CA/USA only)
*Phone		TIN # (if applicable)
*Email Address		*Fax
*Contact Person		Internet URL

SHIPPING INSTRUCTIONS:
As above
*Ship to
*Mailing Address
*Street Address
*City		*State/Region
*Country		Zip (CA/USA only)
*Phone		*Fax
Ship by	UPSFed-ExDHLOther Carrier
Account# - UPS
Account# - Fed-Ex
Account# - DHL
Preferred shipping carrier (if 'other carrier' elected in section above)
*Carrier Name
*Carrier acct. Number
*Mailing Address
*Street Address
*City		*State/Region
*Country		Zip (CA/USA only)
*Phone		*Fax

BILLING INSTRUCTIONS (If different from company address on record)
As above
*Company Name
*Mailing Address
*Street Address
*City		*State/Region
*Country		Zip (CA/USA only)
*Phone		*Fax