Account : Registration form

This information will be used for billing

NOTE: Purchase orders require banking information.
To buy via purchase orders, please download our [ Credit information form ], fill it and returne it to us by fax or regular mail.
Login Name and Password are used to access your personal record online.
Please write them down and keep them in a safe place.
Your Tekniscience's representative*  

* I have read the document [ Terms & Conditions ] and I agree to its entire content.
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