CosimoBooks - User Registration

User Registration Please complete this form to register for online ordering with Cosimo. Asterisks denote the required fields. Once you have submitted the form, you will receive an email within one week confirming your registration. If you have questions or comments, please send us an email at info@cosimobooks.com
Your Contact Information
First Name: *
Last Name: *
Position: *
Phone: *	Ext:
Phone: *
Fax:
E-mail address: *
Password: *

Your Billing Information
Company:
Address: *
City: *
State/Province: *
ZIP/Postal Code: *
Country:

Your Shipping Information
Copy Billing Information to Shipping Information
Company:
Address: *
City: *
State/Province: *
ZIP/Postal Code: *
Country:
Type of Account: *
Name of Bookstore, Institution, Library: *
Comments/Additional Information:

Thank you for registering with Cosimo's online ordering system.