Holylandimports.net : New Wholesale Account Registration

* fields are required

Step 1:
Enter customer information. NOTE: Your E-Mail address will be used as our primary means of contact, so please be sure that you have entered the correct E-Mail address


Customer information

*First name:		* Last name:

*email:

*Password:	(must be at least 4 characters)

*Confirm password:

*Telephone:	fax:
*How did you hear about us?:
If other please specify:

Step 2:
Enter company's information. Please note that in order to open a merchant account you must have a valid tax identification number.


Company information

*Company Name:

*Tax ID Number:

*Resale/ Exemption Certification State:

*Company Type:
Description:

Step 3:
Enter your billing address, it should be the address assigned to your credit card


Billing information

*Billing address:

*city:
*State/Province/Region:

*ZIP/Postal Code:
*Country:

Step 4:
Enter your primary shipping address


Shipping information Use my billing address as my shipping address

*This address is	a residential address a commerical address

*Company Name:
*Attention To:
*Shipping address:

*City:
*State/Province/Region:

*ZIP/Postal Code:
*Country:

Step 5:
Enter the credit card information you would like to use for secure on-line purchases. (All credit card information is submitted over SSL secure lines)

Credit card information (not required until time of purchase)

card type:

card number:

example: 4444-6666-4444-6666

expiration date:

name on card:

(required for card validation)


	Check here if you are an established account and you are preauthorized to order from Holy Land Imports without a credit card. Please note that if you have not received authorization to order without a credit card, your order will be delayed by checking this box.