Customer Registration | Lima Pallet Company

Company Name*

Desired Username*

Primary Contact Information

Contact Name

First Last

Contact Address

Street Address Address Line 2 City State ZIP Code

Contact Phone

Contact Email*

Would you like to add another contact to your account?

Yes
No

Secondary Contact Information

Contact Name

First Last

Contact Address

Street Address Address Line 2 City State ZIP Code

Contact Phone

Contact Email

Would you like to add another contact to your account?

Yes
No

Tertiary Contact Information

Contact Name

First Last

Contact Address

Street Address Address Line 2 City State ZIP Code

Contact Phone

Contact Email

Would you like to add another contact to your account?

Yes
No

Quaternary Contact Information

Contact Name

First Last

Contact Address

Street Address Address Line 2 City State ZIP Code

Contact Phone

Contact Email

Primary Shipping Information

Shipping Contact Name

First Last

Shipping Address

Street Address Address Line 2 City State ZIP Code

Receiving Times

Additional Information

Would you like to add additional shipping information?

Yes
No

Secondary Shipping Information

Shipping Contact Name

First Last

Shipping Address

Street Address Address Line 2 City State ZIP Code

Receiving Times

Additional Information

Would you like to add additional shipping information?

Yes
No

Tertiary Shipping Information

Shipping Contact Name

First Last

Shipping Address

Street Address Address Line 2 City State ZIP Code

Receiving Times

Additional Information

Would you like to add additional shipping information?

Yes
No

Quaternary Shipping Information

Shipping Contact Name

First Last

Shipping Address

Street Address Address Line 2 City State ZIP Code

Receiving Times

Additional Information

Phone

This field is for validation purposes and should be left unchanged.

Customer Information

Primary Contact Information

Secondary Contact Information

Tertiary Contact Information

Quaternary Contact Information

Primary Shipping Information

Secondary Shipping Information

Tertiary Shipping Information

Quaternary Shipping Information

Title