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Please fill out our New Customer Registration Form below. If you're already a customer and would like to shop online, please fill out our New Shopper Form. Required fields marked with an asterisk (*).

Profile Information

* First Name:

Title:

* Email Address:

* Password:

* Last Name:

* Phone:

Fax:

* Verify Password:

Billing Address

* Company Name:

* Address 1:

Address 2:

* City:

* State:

* Zip:

* Country:

Shipping Address

Use Billing Information

* Company Name:

* Address 1:

Address 2:

* City:

* State:

* Zip:

* Country:

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Assembly Fasteners is a wholesale distributor and as such, we only sell to retail and service related businesses. If you are a consumer, please Click Here to request information on Assembly Fasteners dealers in your area.

If you are already an Assembly Fasteners Customer, please Click Here to register for an online account.

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An asterisk (*) indicates a field is required.

Profile Information

First Name

Last Name

Title

Phone

Email Address

Fax

Password

Verify

Bill To Information
*	Company
*	Address1
	Address2
*	City
*	State
*	Zip
*	Country

Ship To Information		use Billing information
*	Company
*	Address1
	Address2
*	City
*	State
*	Zip
*	Country

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New Customer