CUSTOMER CONTROL PANEL

 
New Customer Registration
You may use the Customer ID provided (upon completion) to place orders. Black Outline = Required Fields
Contact Information
Customer/Studio Name :
Primary Contact :
Phone :
Ext :
Mobile :
Fax :
Alt. Phone :
   
Email :
Email (confirm) :
Web Site :
   
Password :
Confirm Password :
Billing Information
Addr 1 :
Addr 2 :
City :
State :
Country :
Zip :
   
Payment Information
Card Type :
Card # :
Exp. Date :
Help us to serve you better!
Years in Photographic Business : years (
   
Approx. sittings per year :
   
Approx. weddings per year :
 
What percentage of your income is derived from photography?
 
 
How did you hear about Diversified Lab?
 
 
What type of photography do you shoot?
 
Portraits
Weddings
School
Sports
Seniors
Glamour
Commercial
Nature
Recreational
Other:
 
 
Do you have any questions for us?
   
PROMOTIONAL CODE :