New Corporate Account Request
If you represent a business, and would like to establish an account with us, complete this form to create your own online account. Once submitted, we will e-mail you your user name along with complete instructions. Alternatively, you may choose to print out this form and fax it along with bank and credit references to 732.389.0010.

If you have any questions or would like further assistance, please contact us at 800.441.1511.
Company Information
Company Name: *  
Contact Name: *  
Contact E-Mail: *
Address Line 1: *  
Address Line 2:
City: *  
State/Province: *  
Zip Code: *    
Country: United States
Phone: *  
Fax:
D&B Number:
Credit Req'd:
Bank Information
TechXtend/Programmer’s Paradise offers a direct credit line to qualified customers. Complete the bank information fields below and we'll set up an account for your organization upon approval. The fields below are optional; you may submit only your company information now and an account representative will fax a credit application to you shortly.
Trade Reference

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PROD-NLB-WEB-01
1157 Shrewsbury Avenue Shrewsbury, NJ 07702-4321 Ph: 800.599.4388 Fax: 732.389.0010
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