Open Account: Step 2

Customer Information Profile - Set up an Account

To Open an Account - Please complete the following information. An Image representative will be contacting you shortly to finalize your account setup. We will need copies of your Tax Resale Exemption Form and Professional License as well as Credit Card information for your future orders.

* Denotes REQUIRED field - these must be filled out or the form will not send. Thank You, Image International.

Prefer paper forms? Print this version of the Customer Information Profile (print & Fax version) and the Treatment Liability Form.