Register Your Coop

Username

Your co-op username cannot be changed. We suggest using a name that is general to your co-op, as opposed to a personal name.

Password

Co-op Name

Group Number (see back of your card)

Use 2203XXXX format

We are new to the program and do not have a Group Number

Co-op Logo

Prefer vector .EPS file - 4-color process (CMYK), 300 minimum dpi

First Name

Last Name

Email

Direct Phone

Fax

Billing Address

Shipping Address (No PO Boxes)

The following items may be used on printed material, so please fill them out as you would like them displayed on the printed material.

Website

Program Contact Person

Program Contact Title

Program Contact Phone

Program Contact Toll-Free Phone

Program Contact Email

Mailing Address