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User Account

Username
Password
Distributor
Restaurant/Retail

Contact Information

First Name
Last Name
Company
Phone
Email
Email Verification
Card Type
Card Number
(not required)
Card Expiration
(not required)
Format: MM/YY
CVV
(not required)

Billing Address

Company Name
Address
City
State/Province
Zip/Postal Code
Shipping Address is the same as Billing Address
 

Shipping Address

Company Name
Address
City
State/Province
Zip/Postal Code