UCC WIRELESS

Current UCC Wireless Customers

If you are already a customer of UCC Wireless and would like to shop online, please fill out our Current Shopper Web Registration Form

New Customer Registration

Complete and submit the form below if you are not yet a customer of UCC Wireless. Required fields marked with an asterisk*

PROFILE INFORMATION

*First Name:

*Title:

*Email Address:

*Password:

*Last Name:

*Phone:

*Fax:

*Verify Password:

BILL TO INFORMATION

*Company Name:

*Address 1:

Address 2:

*City:

*State:

*County:

*Zip:

*Country:

*Terms Requested:

SHIP TO INFORMATION

Use Ship-To Information

*Company Name:

*Address 1:

Address 2:

*City:

*State:

*County:

*Zip:

*Country:

Check here if a Purchase Order is required

Submit

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Profile Information

First Name

Last Name

Title

Phone

Email Address

Fax

Password

Verify

Bill To Information
*	Company
*	Address1
	Address2
*	City
*	State
*	Zip
*	Country

Ship To Information		use Billing information
*	Company
*	Address1
	Address2
*	City
*	State
*	Zip
*	Country

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Contact

62 Jason Court • St. Charles,

MO 63304

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