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Customer Registration

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Username / Password

Email Address *

Confirm Email Address *

Password *

Confirm Password *

Challenge Question

This security question will be used to verify who you are in the event you forget your user password. Please select one security question from the choices available and enter an answer in the box provided.

Challenge Question *

Challenge Answer *

Billing Address

* Residential Address?

Is your billing address a residential address? Yes No

First Name *

Last Name *

Business Name *

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal *

Zip+4

Country *

Phone Number *

Use Billing Address as Shipping Address?

Shipping Address

* Residential Address?

Is your shipping address a residential address? Yes No

First Name *

Last Name *

Business Name *

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal *

Zip+4

Country *

Phone Number *

Email Address *

Additional shipping addresses can be added later.

Additional Information

All student ID’s should start with prefix 410 (Ex. 4101234567). If you're not a student enter your phone number WITHOUT Dashes

Degree Goal

Other

Graduation Year

Example: 2023

Birthday Month

Birthday Day

* Please enter your birthday so that we may send you a greeting.

Email Opt In/Out

I want to receive emails particular to my school.

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