Request a distributors account

To request a distributors account, please fill in the form below. We will reply on your request as soon as possible. 

Notice the password field, where you choose your own password for this account. 

Your password should contain a least 6 characters, of which ONE (1) figure and ONE (1) special character.
for example MICHAELA-1

Your e-mail address will be used a login, which means that you can view the distributors pages with your e-mail address and the password you have choosen.
If you loose your password and you request for a new one, our system generates automaticly a new password, which will be send to your E-mail adress.

 
Company name:
First name:  
Middle name:
Last name:  
E-mail address:  
Password:  
Comments: