WHOLESALE ACCOUNT REQUEST FORM
Do you already have an online account?
Please
click here to log in
.
This online registration form will not work if:
you are located outside the United States, or
you do not yet have a Tax ID number
If we can't get you registered online:
Please e-mail us at
sales@galison.com
, or leave a message for Chrissi at 212 354-8840 ext. 223. We will get back to you the next business day.
First Name
*
Last Name
*
Company
*
TaxID
*
Please
contact us
if you don't have a TaxID Number.
Website URL
Address 1
*
Address 2
City
*
State
*
Zip
*
Country
USA [If international, click
here
]
Please
contact us
if you are outside the U.S.A.
Phone
*
Fax
Email (this will be your username)
*
Password:
*
Confirm Password:
*
Please enter your billing information next.
You may place an order immediately by using a credit card. For standard net 30 payment terms, we will ask for bank and trade credit references on another screen. If you already have a traditional account with us, you may choose the "Call me" option at checkout to apply your standard account terms.
*
Required fields
You may also fax this information to us at: 212.944.8682 or email it to
sales@galison.com
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