Wilson Dependable Services

New Marketplace Account Application

Authorized Representative & Marketplace Administrator

First Name: *

Last Name: *

Job Title: *

Company/Organization Name: *

Email Address: *

Phone Number: *

Username (email address): *

Password: *
Note: Password field must be at least 8 characters long.

Confirm Password: *

Instructions

Required fields indicated with an asterisk (*)

Please enter the contact, billing and shipping information for your organization. The Authorized Representative will be the account administrator and can add and view additional users. We will create the new account and contact you once we have reviewed your account information.

Once the account has been approved, you can use this login to start purchasing from the marketplace.

If you need assistance, we can be reached via email at support@wdslifesci.com

Same as Billing

Primary Billing Information

We use this information as the default billing address for new users.

First Name: *

Last Name: *

Email: *

Agency Name: *

Country: *

Street Address: *

Street Address 2:

City: *

State: *

Postal Code: *

Phone: *

Primary Accounts Payable Email:

Is Your Agency Tax Exempt: *

If Exempt, please upload your Tax certificate:
Enter "Wilson Dependable Services" in Company Section.
PDF or Word Format

Primary Shipping Information

We use this information as the default shipping address for new users.

First Name: *

Last Name: *

Email: *

Agency Name: *

Country: *

Street Address: *

Street Address 2:

City: *

State: *

Postal Code: *

Phone:

Categories

Electronic

Accessories & Parts

Computer & Technologies

Menu

New Marketplace Account Application

Authorized Representative & Marketplace Administrator

Instructions

Primary Billing Information

Primary Shipping Information