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Hylok Registration

Step 1 - Basic Information

Email Address:
Password:
Confirm Password:

First name:
Surname:
Contact No (Work):
Contact No (Mobile):
Contact No (Fax):

Step 2 - Delivery Information

Shipping Address

Address Line1:

Address Line2:

Suburb:

State:

Postcode:

Country:

Billing Address as a Shipping Address?

Address Line1:		Address Line2:		Suburb:
State:		Postcode:		Country:

Step 3 - Options

Website Address:
On Account:	I wish to be contacted to set-up an Account.
Disclaimer:	Disclaimers can be made up out of statements covering different legal aspects. Below are some sample disclaimer statements that can be used for each aspect independently. To make up your disclaimer, select statements for the different aspects you wish to cover and include these in your disclaimer. Replace 'the company' with your company name and if possible use merge fields to make the disclaimer more specific, such as including the recipient name. Agree to Disclaimer

Congratulations you have successfully registered to Purchase from Hylok. An email has been dispatched to the email address you specified. You will need to confirm your account by clicking on the link. This will finalise your account status.

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