Form

Below is our Registration Form for our online ordering system, BSonline2. It is VERY important that you fill out all the necessary information so that we have accurate information about your agency.

USER INFORMATION

ND Agency Name*

First Name*

Last Name*

Phone #*

Ext #

Email Address*

Please describe type of user*

Primary User Additional User

I have an Open Account with Brown & Saenger

Yes No I don\'t know

B&S Account # (You can locate this on an invoice or statement)

Dept# (If Applicable)

Billing Address (Line 1)

Billing Address (Line 2)

City

State

Zip Code

Billing Contact Name

Billing Phone #

Shipping Address (Line 1)*

Shipping Address (Line 2)

City*

State*

Zip Code*

Ship Attention to*

Credit Card Options

Yes, Credit Cards MUST be used w/purchase Yes, Credit Cards are allowed, may also bill No, we do not allow Credit Cards

If Account has departments or profit centers, are you as a user allowed to order for ALL departments?

Yes, we have depts, and I order from all Yes, but I can only order from ONE dept No, we do not have departments

If you can order from only one department, what is the department # or Name?

Do you order for more than 1 account?*

Yes No

If you do order for more than 1 account, what are the account #'s?

Account #2

Account #3

Allow statement to display & payments made online?*

Yes No

Do you need to have your purchases approved by another person?*

Yes No

If you need approval, what is the approvers email address?

Other information we may need to know

Thank you for taking the time to fill out the registration form. We will email your username and password as soon as possible.