Registration Form

Please complete the form below to request access to Timex B to B Online. Timex will review your application. If accepted, you will receive your login information via e-mail.

Bold text indicates a required field.

Company and Personal Information

Customer number:	If available
Company name:
Tax ID:
Courtesy title:
First name:
Middle name:
Last name:

Address Information

Billing Information

Address 1:
Address 2:
City:
State:
Zip code:	5 digits only
Country:

Shipping Information (Optional)

Shipping Information same as Billing.Yes No

Address 1:
Address 2:
City:
State:
Zip code:	5 digits only
Country:

Use the comment box at the bottom of the form for entering multiple shipping addresses.

Contact Information

Phone:	Numbers Only. No Spaces.
Extension:
Fax:
E-mail:

Would you like to be included in our mailing list?Yes No

Comments: Maximum 1000 characters

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