You would then complete the four sections of this form.
Section 1:	You will identify your Reseller Code again, this feature is for your security.
Section 2:	Information pertaining to your new client.
Section 3:	General Contact email. Please use billing@authotrans.com in this blank. This will ensure your office receives credit for your new client account.
	Email for Orders: This is your client’s email address
	Email for Order Form Errors: This is your client’s email address
Section 4:	This area allows you to establish a Password for your new client account.

1. RESELLER INFORMATION

Reseller CODE:

2. GENERAL INFORMATION

Business Name: (If no business name, enter contact name.)
First Name:	Last Name:
Title:
Address:
City:	State: Zip:
Country:
Web Site URL:
Contact Phone Number:
Customer Service Phone:
Fax Number:

3. EMAIL INFORMATION

General Contact Email:
Email for Orders:
Email for Order Form Errors:

4. PASSWORD Please select a password. It must be six to ten characters in length. Since this may be changed at any time by the merchant, you may enter a generic password. Please be sure to let your merchant know what password you have chosen.

Password:
Verify Password: