Registration - EzeCleanse

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Register
Please fill in your account details below
Name*
First Last
Email*
Please enter your account's email. The email must be unique and not already be associated with an existing account.
Enter Email Confirm Email
Password*
Enter Password Confirm Password

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What type of account would you like to apply for:*

A retail account allows you to instantly purchase retail items for personal use.

A wholesale account allows you to purchase trade items; and retail items at trade prices. Please allow up to two working days for your account to be approved.
*Please note: a wholesale account requires a minimum opening order of $250 upon activation. (Excludes existing TechnoTan Trade customers. )
- Retail
- Wholesale

Contact Information
Address*
Please enter the address associated with this account (The address associated with your business if you intend on creating a wholesale account)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Number
Country
Referral Source*
How did you hear about us?
- Internet
- Advertising
- Facebook
- Referred by friend
- Other
Other

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