Account Set-up / Payment Authorization

Account Detail

Company Name (It will be your Username) *

Purchasing Contact First Name *

Accounting Contact (If Different Contact)

Email Address *

Confirm Email *

Phone Number *

Purchasing Contact Last Name *

Password *

Confirm Password *

Select Sales Rep

Billing Address

Address 01 *

Address 02

Country *

Town / City *

State / County *

Postcode / Zip *

Shipping Address (If Different than Billing)

Address 01

Address 02

Country

Town / City

State / County

Postcode / Zip

Resale Certificate Number (Attach Copy)

Drop your file here or click here to upload You can upload up to 1 files

Note:

This is not required to order, but you will be charged 7% sales tax if you cannot provide a valid resale certificate.

Credit Card Info

Your card will never be charged until you approve your product, and your product actually ships

Name on Card *

Credit Card Type *

Credit Card # *

Expiration Date *

Security Code *

Note:

Filling out this form authorizes Slant Six LLC. to charge the full amount of your total invoice at the time of order, including shipping charges (from our warehouse to your location).