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Registration

Greetings,
Thank you for your interest in registering with IPM Lithographics Inc. Please carefully complete the application below to apply for a on-line membership. Upon review and confirmation of your business entity, you will be notified (via e-mail confirmation) that your account has been activated or denied.

	Billing Information
	Please enter your primary billing information. Your e-mail is your user name when logging in. (* indicates required fields)
	First Name: *
	Last Name: *
	Company Name:
	Address: *
	Apt No./Suite No.:
	City: *
	State: *
	City Zip: *
	Phone Number: *	ext.
	Fax Number:	ext.
	User's Email: *
	Password: *

Shipping Information
Same as Billing Address
My Ship to Address is Different than my Billing Address

	First Name:
	Last Name:
	Company Name:
	Address:
	Apt No./Suite No.:
	City:
	State:
	Zip Code:
	Phone Number:	ext.
	Fax Number:	ext.

Website Contact Information
Same as Billing Address
Same as Shipping Address
Website Contact is Different than Billing or Shipping Addresss Contact

	First Name:
	Last Name:
	Company Name:
	Address:
	Apt No./Suite No.:
	City:
	State:
	City Zip:
	Phone Number:	ext.
	Fax Number:	ext.

Resale Information
No, I do not resell printing services
Yes, I do resell printing services and I have a Valid Resale Number

	Name of Purchaser:
	Company Name:
	Address:
	City State Zip:
	Seller's Permit No.:

	Issued pursuant of Sales & Use Tax Law that I am engaged in the business of selling:
	I certify that I hold the above valid seller's permit.