Registration

How It Works
Wireox only deals with wholesale customers, our account opening process steps.

Fields with '*' are required to fill

E-Mail is required
Email is required
Password is required.
Confirm password is required
First name is required
Last name is required
Company is required
Company Address is required
City is required
Company Zip is required
Company Phone is Required
Company Fax is Required
Company Cell Phone is required
Please answer how did you hear about us?

E-Mail / LoginID:

Re-Type Email / Login ID :

* *	NOTE 1 This Email address will be used for all correspondence 2 your user id/Login ID will be your Email
* * *

Password: *

Password Confirmation: * *

Name

*	*
First Name:	Last Name:

Business Info

*
Company Legal Name:	D/B/A:	Resale Tax ID:	Business Type:

Select your ordering level *
Normal Wholesale Distributor	(Retail) (Monthly Order Value $500 - $1,000) (Monthly Order Value $1,500 - $5,000)

This address and info will be used as your main address and billing address, You can add more shipping address once your account is created through, “MY ACCOUNT” link at the menu bar

Address

*
Street Address:		Street Address2:
*		*
City:	State:	Zip:	Country:
**	**	*
Phone:	Fax:	Cell Phone:	Web address:

Please make sure to provide a contact number where we can easily reach you for the confirmation of data

Bank References

Bank:			Phone:	*		Fax:			Contact:
Bank:			Phone:	*		Fax:			Contact:

Options

I would like to receive newsletters:
I agree to Terms and Conditions	*

Survey

How did you hear about us? *

Registration

How It Works