Nomination - Retailer Website

This form is for use by authorized Nomination retailers ONLY. If you are an end-user, please visit our consumer website. If you are a retailer interested in selling Nomination, please fill out our "Become a Nomination Retailer" form.

Please enter all the information below. The most recent invoice number and total amount are used for verification. The invoice number is shown in the upper right corner of the invoice, and the total amount in the lower left corner.

After you submit this form, a Nomination representative will review the information you entered and (if everything is correct) approve your access request. At this point you will receive an email (at the address you entered) with further activation information. This process usually takes 3-4 business days.

All fields are required unless specified otherwise.

Store name

Your most recent Nomination invoice number
Total amount shown on that invoice

Your name
Phone number
Email address (this is the address where we will send your activation information, as well as your password if you ever forget it)
Retype email address
Choose a username - at least 6 characters
Choose a password - at least 6 characters
Retype password
Comments (optional)

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