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Member Registration Form
* bold fields are mandatory.
Personal Information
*First Name
*Last Name
*Email
*Confirmed Email
*Day Phone
Night Phone
Fax
Company(Store Name)
TaxID
Login Information
*UserID(Email) Ajax Indicator
*Password   Confirmed Password
Shipping Address Information
*Country
*Address
Address(line 2)
*City
*State/Province
*Zip/Postal Code