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Create Customer Account:

Please fill out the form below to create a customer account.
 *  = Required
Note: This is only your shipping and contact info.
ALL ONLINE TRANSACTIONS WILL BE MADE OVER SECURE SERVER
* First Name: 
ex: Bob
* Last Name: 
ex: Smith
Company: 
ex: Whatever inc.
* Address 1: 
ex: 123 Tree St.
Address 2: 
ex: Apt. 2
* City: 
ex: Vancouver
* State: 
ex: BC
* Country: 
ex: Canada
* Zip / Postal Code: 
ex: 90210
* Phone Number: 
ex: 555-123-1234
Cell Phone Number: 
ex: 555-123-1234
Fax Number: 
ex: 555-123-1234
*Date Of Birth: 
Year: Month: Day:
Age Must Be >= 18
* Account Email: 
ex: me@you.com - This is the email you use to login to account and is where all our order status emails are sent
* Confirm Account Email: 
Enter same email address as above to confirm correct address
* Account Password : 
ex: 123ME45
Use this to login to your account,
* Confirm Account Password : 
ex: 123ME45
Use this to login to your account,