Registration
Customer Data
  *First Name
  *Last Name
  *Phone Number
  *Email (use this to log in)
  *Password (4-10 Characters)
  *Re-Enter Password

Customer Details
Billing address
  * Institution / Company Name
  * Department
  *Address
  Address Line 2
  Address Line 3
  Address Line 4
  *City
  *Province/State
  Another Province/State
  *Postal Code/Zip
  *Country

Shipping address ( Same as Billing Address)
  *First Name
  *Last Name
  * Institution / Company Name
  * Department
  *Address
  Address Line 2
  Address Line 3
  Address Line 4
  *City
  *Province/State
  Another Province/State
  *Postal Code/Zip
  *Country

  * required field
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