/$body Content-type: text/html Expires: Fri Jan 01 1999 00:00:00 New User Registration
860 East Main Ave.
Zeeland, MI 49464-1231
616-772-9131: Voice
616-772-7345: Fax		 Register as a New User
         

REGISTRATION - Current Dealers Only

* Required Fields.
 

CREATE PASSWORD

*EMAIL:

*PASSWORD:

10 Characters or Less

*CONFIRM    PASSWORD:


COMPANY INFORMATION

*COMPANY NAME:

*BILLING ADDRESS:

   BILLING ADDRESS:

*CITY:

*STATE:

Use IT if not U.S. or Canada

   COUNTRY:

*ZIP CODE:


CONTACT INFORMATION

*FIRST NAME:

*LAST NAME:

*PHONE:

   FAX:


CROSS REFERENCE

* ENTER YOUR HOWARD MILLER CUSTOMER NUMBER:


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