Create New Customer Account

1. Personal Information

Name

Title

First Name

Last Name

Confirm Email Address

Mobile Phone (Please do not use spaces)

Phone Number (Please do not use spaces)

2. Account Information

Password Your password must contain at least one of each of the following, lower case character, upper case character, special character, numerical character

Password Strength: No Password

Confirm Password

Account Type

Company Reg. Number

EORI Number (N. Ireland commercial customers) What is an EORI number?

Type of Business

Are you part of a Group/Company with Brosch Direct contracted pricing in place?

Please state the group you are part of (Please note that it may take up to 2 working hours for your account to be verified. We will contact you as soon as this has be completed)

Do you already have an account with us, but are not registered online?

Account number (Please enter your account number, if you do not have it to hand please contact us before registering)

Where did you hear about us?

Other

3. Address Information

Zip/Postal Code

Company

Street Address

Street Address 2

Street Address 3

City

County

Country

I/We accept the Brosch direct Terms and Conditions

Create New Customer Account

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