Create a FIRESCOPE Customer Record (* Indicates a Required field)

Login ID & Password

E-Mail address: *  (This will be used as your login ID)

Re-enter your E-Mail address: *

Password:  * Re-enter your Password:  *
Customer Name, Type & Agency
First Name:   * Last Name:   * Agency/Business Name: * (Attn: Business Customers, PLEASE Enter Name as you wish it to be displayed on your package's Shipping Label )
Customer Type:   *
Shipping Address
Street: *  P.O. Box: City: * State: * Zip: *
Country: *
Phone: * FAX:

Billing Receipt Address
( ENTER ONLY~ If you need to have your payment receipt and or order invoice delivered to an address that is different than your shipping address, if so, enter that address below)

Name: Branch:
Street:     P.O. Box: City:   State:   Zip:  
Country:
Phone: FAX:
E-Mail:
Tax Exempt/Resale Certificate #

Tax Exempt/Resale Certificate #:  (California Customers only) To be considered valid, you must supply a copy of your certificate to FIRESCOPE. Certifcate can be faxed to: (951) 784-3026, emailed to: teresa.romero@calema.ca.gov or delivered to: FIRESCOPE attn. Docon ~ 2524 Mulberry St. Riverside, CA 92501.