Online Ordering Setup
Up to five employees may be set up for online ordering.
JCS Account Number
New customer? (check if new)
Company Name *required
Department (if applicable)
Supervisor User (Primary responsiblity for account)
First Name
Last Name
Email Address *required
Preferred Username
(6 characters, letters or numbers)
Preferred Password
(6 characters, letters or numbers)
Do you require PO's when ordering?
Do you use credit cards when purchasing?
Do you only use credit cards when ordering?
Complete this section only if you need to set up multiple users. If not, proceed to the bottom of this form and submit.
First Additional User
First Name
Last Name
Email Address
Preferred Username
(6 characters, letters or numbers)
Preferred Password
(6 characters, letters or numbers)
Yes    No
Will this user requre someone else to approve his or her order?
If Yes to above, who will approve orders?
Second Additional User
First Name
Last Name
Email Address
Preferred Username
(6 characters, letters or numbers)
Preferred Password
(6 characters, letters or numbers)
Yes    No
Will this user requre someone else to approve his or her order?
If Yes to above, who will approve orders?
Third Additional User
First Name
Last Name
Email Address
Preferred Username
(6 characters, letters or numbers)
Preferred Password
(6 characters, letters or numbers)
Yes    No
Will this user requre someone else to approve his or her order?
If Yes to above, who will approve orders?
Fourth Additional User
First Name
Last Name
Email Address
Preferred Username
(6 characters, letters or numbers)
Preferred Password
(6 characters, letters or numbers)
Yes    No
Will this user requre someone else to approve his or her order?
If Yes to above, who will approve orders?
Fifth Additional User
First Name
Last Name
Email Address
Preferred Username
(6 characters, letters or numbers)
Preferred Password
(6 characters, letters or numbers)
Yes    No
Will this user requre someone else to approve his or her order?
If Yes to above, who will approve orders?