Dictaphone Store New Customer Registration

Shopper Registration
Please register with Dictaphone On-Line Store before ordering from our secure server.

Create an Account
	User Name*(white spaces not allowed)
	Password*
	Password Confirm*

Enter Organization Information
	Type of Business*
	If Other, indicate the type of business
	If Healthcare, select the number of physicians in the organization
	Are you exempt from Sales Tax?
If you check the above box please fax a copy of your state exemption certificate to 800-339-6420(FAX) for Medical Related, or 888-414-4836(FAX) for "Non Medical".

Enter Billing Information
	First Name*
	Last Name*
	Company
	Address1*
	Address2
	City*
	Region/State/Province*
	Country*
	Zip*
	Phone*
	Email*(Please double check as all notifications will be sent to this email)
	Fax
	May we send you emails?
	Shipping information same as billing information?