Account Application Form

Please note: Floridus Design Images is a wholesale company that only sells to retail businesses. We do not sell directly to the public. You must have a registered business to apply for an account.

Company Name	*
Address	*


City	*
State/Province	*
Zip/Postal Code	*
PST Exception Number	Note: Ontario retailers must provide a PST exception number.
Telephone	-- *
Fax	--
Your Name	* Eg. John Doe
Your Email Address	* Eg. johndoe@hotmail.com
Desired Password	*
Confirm Password	*
I wish to be contacted by	*
How did you hear about us?

Thank you for taking the time to apply for an account with us. Our accounts department will contact you to confirm your account details and to inform you of your new account number once your application has been processed.

Already have an account?

If you already have an account you can begin using it online immediately. Click here to add a password to your existing account.

Please provide a phone number or email address where you can be reached during regular business hours.