Electronic Commerce ID Request

The online application is the fast, easy way to register for an Electronic Commerce ID. A Kettenbach account number is all you need to request an Electronic Commerce ID and password which gives you access to secure areas of our site. To expedite the application process, please make sure that you have the following information available and that your computer meets the requirements below.

You will need a Resale Certificate or State License Number, Business address information, Business trade information and State Licensing Board Credential information. Ensure cookies are enabled in your web browser.

To access the full functionality of our website, cookies and JavaScript must be enabled in your browser preferences. Disabling any of these features or using an outdated browser may mean that you will not be able to take full advantage of our site. If you have a pop-up blocker installed, some functionality may be blocked on our site. Some documents may require acrobat reader, download the latest version from Adobe.

A completed application and certificate will be emailed to you for your signature. The application should be printed and submitted to us. For security reasons, we do not allow a digital copy of your online application.




On Line Electronic Commerce ID Application


Please provide the email address you will use to authorize your application, and then give us a little information about yourself.

Your Electronic Commerce ID and Password will be emailed to you within 3 to 5 business days after registering.

* Required Fields

Communication Information
Email Address: *
Confirm Email Address: *
Day-time Phone Number: *

About Me
Prefix:
First Name: *
M.I.:
Last Name: *
Suffix:
Title:

Contact Information
Account Number:
Practice, DBA or Company: *
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Business Phone Number:

State Licensing Board Credential Holder
Prefix:
First Name:
M.I.:
Last Name:
Suffix:

State Licensing Board Credential Verification
Licensing State:
License Number:

Shipping Information
My Shipping Address is the same as my Company Address
Location Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Location Phone Number:

Billing Information
My Billing Address is the same as my Company Address
Practice, DBA or Company:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Billing Phone Number:

Terms of Use
I Agree:
By clicking the "I Agree" checkbox, I certify that I have read and agree to the Web Site Terms.
I Agree:
By clicking the "I Agree" checkbox, I certify that I have read and agree to the Terms and Conditions of Sale.