Supplier's Registration

Account Info
*Login:				Login can't be empty Please enter correct login
*Password:				Password can't be empty Passwords must consist of at least 6 letters and/or numbers
*Confirm Password:				Password can't be empty Passwords must consist of at least 6 letters and/or numbers
*Company Name:				Company name can't be empty Please enter correct company name
*E-mail:				Company email can't be empty Please enter correct company email
*Phone (in format 999-555-5555):				Company phone can't be empty Please enter correct company phone
*Fax:				Company fax can't be empty Please enter correct company fax
Owner Contact Info
*First Name:				Owner's first name can't be empty Please enter correct owner's first name
*Last Name:				Owner's last name can't be empty Please enter correct owner's last name
*E-mail:				Owner's email can't be empty Please enter correct owner's email
*Phone (in format 999-555-5555):				Owner's phone can't be empty Please enter correct owner's phone
*Cell Phone (in international format):				Owner's cell phone can't be empty Please enter correct owner's cell phone
*Home Phone:				Owner's home phone can't be empty Please enter correct owner's home phone
*Fax:				Owner's fax can't be empty Please enter correct owner's fax
Alternate Fax:				Please enter correct owner's alternate fax
Web Site:				Please enter correct owner's web site
Manager / Sales Person Contact Info
	Same as Owner Contact
*Title:	General Manager Office Manager Sales Manager Operations Manager
*First Name:				Manager's first name can't be empty Please enter correct manager's first name
*Last Name:				Manager's last name can't be empty Please enter correct manager's last name
*E-mail:				Manager's email can't be empty Please enter correct manager's email
*Phone (in format 999-555-5555):				Manager's phone can't be empty Please enter correct manager's phone
*Cell Phone (in international format):				Manager's cell phone can't be empty Please enter correct manager's cell phone
*Home Phone:				Manager's home phone can't be empty Please enter correct manager's home phone
*Fax:				Manager's fax can't be empty Please enter correct manager's fax
Home Fax:				Please enter correct manager's home fax
Emergency Contact Info
*Contact Name:				Emergency contact name can't be empty Please enter correct emergency contact name
*Phone: (in format 999-555-5555):				Emergency contact phone can't be empty Please enter correct emergency contact phone
*Cell Phone (in international format):				Emergency contact cell phone can't be empty Please enter correct emergency contact cell phone
*Fax:				Emergency contact fax can't be empty Please enter correct emergency contact fax
Company Address
*Address:				Company street address can't be empty Please enter correct company street address
*City:				Company city can't be empty Please enter correct company city
State/Province:
Zip Code:				Zip should contain digits only
*Country:	Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo ngo, Democractic Republic Cook Islands Costa Rica Cote D'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Islas Malvinas) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong S.A.R. Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea orea, North Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau S.A.R. Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles Netherlands, The New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua new Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts And Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent And The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States U S Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis And Futuna Islands Yemen Yugoslavia Zambia Zimbabwe Sarbia
Billing Address
	Same as Company Address
*Address:				Billing street address can't be empty Please enter correct billing street address
*City:				Billing city can't be empty Please enter correct billing city
State/Province:
Zip Code:				Zip should contain digits only
*Country:	Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo ngo, Democractic Republic Cook Islands Costa Rica Cote D'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Islas Malvinas) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong S.A.R. Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea orea, North Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau S.A.R. Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles Netherlands, The New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua new Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts And Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent And The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States U S Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis And Futuna Islands Yemen Yugoslavia Zambia Zimbabwe Sarbia
Global Discounts
PLANTS:	%			Discount can't be empty Discount must be in range 0-99
AQUATIC PLANTS:	%			Discount can't be empty Discount must be in range 0-99
WOOD:	%			Discount can't be empty Discount must be in range 0-99
LIVE ROCK:	%			Discount can't be empty Discount must be in range 0-99
FOOD:	%			Discount can't be empty Discount must be in range 0-99
SALT WATER:	%			Discount can't be empty Discount must be in range 0-99
FRESH WATER:	%			Discount can't be empty Discount must be in range 0-99
REPTILES:	%			Discount can't be empty Discount must be in range 0-99
DRY GOODS:	%			Discount can't be empty Discount must be in range 0-99
CORALS:	%			Discount can't be empty Discount must be in range 0-99
Special Discounts
	%	Override Global
Questionnaire (optional)
1. What are your strongest Categories of Tropical Fish & Marine Life you supply?
	Fresh Water Salt Water Corals Plants Reptilies
2. What are the Markets do you currently Ship to?
	United States Europe Japan Other Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo ngo, Democractic Republic Cook Islands Costa Rica Cote D'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Islas Malvinas) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong S.A.R. Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea orea, North Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau S.A.R. Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles Netherlands, The New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua new Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts And Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent And The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States U S Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis And Futuna Islands Yemen Yugoslavia Zambia Zimbabwe Sarbia
3. If you are shipping to the United States what States do you ship to the Most?
	California New York Texas Georgia Michigan Other
4. Do you have any exclusive Contracts with any Buyers in a given Country?
Yes No What Country? What State?
5. How long has your Company been in Business?
6. How long has the present Owner of the Company owned the Business?
7. Which products or services are you interested in selling through FishExchange.com?
Tropical Fish
Please specify categories you currently offer and from what regions.				This field cannot contains more than 100 symbols.
Packing Materials
Please specify what packing materials you currently offer.				This field cannot contains more than 100 symbols.
Aquariums & Accessories
Please specify what type of aquariums and/or accessories you currently offer.				This field cannot contains more than 100 symbols.
Other Fish Supplies
Please specify other goods you currently offer.				This field cannot contains more than 100 symbols.
What regions do you currently sell to?
Please use this space to provide any additional information that you wish to provide or to ask any questions you have.
				This field cannot contains more than 100 symbols.