Become a member to receive discounts

    Please fill out this form so that we can offer you a discount on our on line of products. Discounts can range from 10 to 30 percent and you will be notified by e-mail as to what discount you qualify for. You must include a login and password so we can activate your account. Activation can take from one to two weeks at which point you will be notified. You will also receive  e-mail notifications as to specials and special events. You can remove yourself from our list at any time. All of this information is private and will not be sold or passed on to anyone else. 

Please provide the following contact information:

*First Name
*Last Name
Title
*Organization
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Country
Work Phone
FAX
**E-mail

Please provide your account information:

*User Name
*Password
*Confirm Password

*Choose one of the following options:

Restaurant
Reseller
Repair Shop
Institution 

*Necessary information

Copyright © 2001 [FIXITSHOP.COM]. All rights reserved.
Revised: June 15, 2001