If you already have an account with Azur, please
Do not fill out this form!

PLEASE RETURN TO THE LOGIN SCREEN FOR INSTRUCTIONS.

NEW CUSTOMER REGISTRATION FORM
Welcome to Azur Global Imports. We offer our products to licensed dealers only.
We do not sell to the General Public.
All fields marked with an asterisk * are required.
*Company Name:
*Your Name: *First: MI: *Last: 
*Title:
*Email:
*Confirm Email:
Phone Format: United States: nnn-nnn-nnnn   
International: (country code) nnnnnnnnn
(Do not include leading zeros or special characters such /, + or #)
*Phone:
Fax:
Mobile:
Web Address:
*What best describes your business:
No. of Locations:
*Please quote my prices by: Weight(Grams) Piece 
*How did you hear about us?
*User Name:
*Confirm User Name:
*Password:
*Confirm Password:
Password must be at least 6 characters. Include at least 1 number.
These special characters are also allowed: ! # $ * { } @.
Address Information
Billing Address
*Name:
*Phone:
*Address:
Address2:
*City:
*State/Province:
*Zip/Postal Code:
*Country:
Shipping Address SAME AS BILLING
*Name:
*Phone:
*Address:
Address2:
*City:
*State/Province:
*Zip/Postal Code:
*Country:
Is this Address:  Residential
USA Customers Only
Certificate of Resale
The undersigned hereby certifies that all tangible personal property hereafter purchased from Azur Global Imports is for the purpose of resale and shall be considered a part of every order, unless otherwise stated or until revoked by us. In the event that property is purchased free of sales tax pursuant to the issuance of the certificate and is later used for taxable purpose, I assume all liability for sales tax or use tax.
*Tax ID:
*I Agree to the terms of this certificate
International Customers Only
Policy: All International Orders require a minimum order of US $350
*I accept this condition