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Registration Form

This Registration Form will enable Nexus Information Systems to assign a unique user login name
and password for your company. This login and password will enable you to use the catalog to search for items, create Quotes, Orders, and purchase products and services online. After registering, you will be notified by email that your Registration has been accepted and confirming your login name and password.
If you have any questions, comments, or concerns please
contact Nexus Information Systems at 763-548-8300.
Red fields are required.
Your Name and Address:
Your Name:
Your Title:
Company Name:
Address Line 1:
Address Line 2:
City:
State:
Zip:   +4
 

How can we reach you? Please use this format: 123-444-5678
Phone:
Fax:
Email address:
   
Customized Shipping: Do you want the company address entered above listed as your default shipping address?
Yes- Use Address Above     No- Do Not Use Default Shipping Address
   
Information about Your Company:
Number of Locations:
Number of Sales Reps:
Estimated Annual Revenue:
Do you have Fortune 1000 Customers? Yes     No
Company URL Address:
Thank you. You will be notified by email
when your Guest Login and Password are activated.
   
 

  

 
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