ONLINE ACCOUNT REGISTRATION

NOTE: Online account registration is only avalable for current customers.

ACCOUNT TYPES

ORDERING:
By authorizing these individuals, you are permitting them to place orders on your behalf. They will also have access to dilution ratios and various spreadsheets to assist in setting up and running Qual Chem chemistry.

TECH:
By authorizing these individuals, you are permitting them to have access to dilution ratios and various spreadsheets to assist in setting up and running Qual Chem chemistry.

Company Name *

Your Name *

Your Email *

Acknowledgement *

I authorize the following users to act on our behalf as outlined above.

REP INFO

Rep #1 Name *

First

Last

Rep #1 Email *

Rep #1 Desired Password

Rep #1 Account Type

Rep #2

Rep #2 Name

First

Last

Rep #2 Email

Rep #2 Desired Password

Rep #2 Account Type

Rep #3

Rep #3 Name

First

Last

Rep #3 Email

Rep #3 Desired Password

Rep #3 Account Type

Website