Symbiotic Customer Registration Form

New Account Form

New Account

Account Change

Today's date

YYYY

Check One

Salon Owner

Stylist

Renter

Owners Name

Salon Name

Salon Address

Commercial

Salon Phone Number

Salon Fax Number

Cell Phone Number

Note: Your email is used to confirm your identity in our client registration process.

Rep Name

Credit Card

I will be using a credit card (Please fill out Credit Card Authorization Form)

I will not be using a credit card

Sales Tax

I have provided my Resale Tax Certificate (can be uploaded below)

I authorize Symbiotic Salon Systems to charge me sales tax, since I have not provided a Resale Tax Certificate

I hereby agree to pay any and all outstanding debts incurred by me to Symbiotic Salon Systems . $30 Returned check charge

Print Name

Digital signature

I hereby declare that the information submitted through the New Client Registration Form are true and correct to the best of my knowledge and belief

Upload Tax Certificate

Delete all uploads

Choose files or drag here

Upload Cosmetology License and/or business licence

Delete all uploads

Choose files or drag here

Would you like to receive promotional material from us?

Yes