Retailer Registration Page
Aurora Fused Glass
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Retailer Registration Page
Member Registration
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Username
Usernames must be at least 4 characters long
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Password
Passwords must be at least 5 characters long
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Password Confirm
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Screen Name
If you leave this field blank, your screen name will be the same as your username
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Email Address
URL
Store or businss name
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Your First Name
Enter your business' primary contact or buyer's first name.
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Your Last Name
Enter your business' primary contact or buyer's last name.
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Phone number
Please include area code.
Fax
Please include your area code.
Email
Enter your business or personal email account.
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How did you find Aurora Fused Glass:
If you were introduced to Aurora Fused Glass in a showroom, please list the show. If you were introduced to Aurora Fused Glass by a sales representative, please tell us his/her name. If you just found us on this website, type "website."
Business Tax Number
Web Site
If your store or business has a website, please enter the URL here. Include the full address: ( i.e. http://www.yourstorename.com) This record will be used to populate our "Store Locator" page.
List address information on our store locator page
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No
Store Owner Name
Please enter the name of the store owner if different from the above.
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Street address
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City
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State / Province
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Zip / Postal Code
Country
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How should we contact you?
Email
Phone
Fax
Billing address: Name of business
For billing purposes only: enter if it is different from the above.
Billing address: Street or P.O.
For billing purposes only: enter if it is different from the above.
Billing address: City
For billing purposes only: enter if it is different from the above.
Billing address: State
For billing purposes only: enter if it is different from the above.
Billing address: Zip / Postal Code
For billing purposes only: enter if it is different from the above.
Billing address: Country
For billing purposes only: enter if it is different from the above.
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