State of SD Registration Form

Below is our Registration Form for our online ordering system, BSonline2. It is VERY important that you fill out all the necessary information so that we have accurate information about your agency.

USER INFORMATION

SD Agency Name

First Name

Last Name

Phone #

Ext #

Email Address

Please describe type of user

I have an Open Account with Brown & Saenger

B&S Account # (You can locate this on an invoice or statement)

Dept# (If Applicable)

Billing Address (Line 1)

Billing Address (Line 2)

City

State

Zip Code

Billing Contact Name

Billing Phone #

Shipping Address (Line 1)

Shipping Address (Line 2)

City

State

Zip Code

Ship Attention to

Credit Card Options

If Account has departments or profit centers, are you as a user allowed to order for ALL departments?

If you can order from only one department, what is the department # or Name?

Do you order for more than 1 account?

If you do order for more than 1 account, what are the account #'s?

Account #2

Account #3

Allow statement to display & payments made online?

Do you need to have your purchases approved by another person?

If you need approval, what is the approvers email address?

Other information we may need to know

Thank you for taking the time to fill out the registration form. We will email your username and password as soon as possible.