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Apply for an Account Number

Please fill out the form below to apply for your Boreal Science account number. Upgrading your basic account to a full account will allow you to customize portions of the site to make your shopping experience more convenient. A full account is also required if you have a need to purchase restricted or licensed products.

Enter Your Billing Information
       
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First Name:   *  
Last Name:   *  
School or Company Name:   *  
Address 1:   *  
Address 2:    
City:   *  
State/Province:   *  
Postal Code:   *  
Country:   *  
Phone Number:   *   Ext:   
       
Enter Your Shipping Information ** Please note that we will not ship to a residential address.**
Same as Billing info?:    
       
First Name:   *  
Last Name:   *  
School or Company Name:   *  
Address 1:   *  
Address 2:    
City:   *  
State/Province:   *  
Postal Code:   *  
Country:   *  
Phone Number:   *   Ext:   
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