J.H. Larson Company Electronic Customer Service Center User ID & Password Application

	An open account with J.H. Larson is required in order to establish an ECSC account. Please fill out our credit application to apply for an open account.
	For faster processing, please complete all the following information and submit to the address given below. Please complete the form below for each employee. If this User ID and Password are to be established for an employee who is not a Principal, we also require the authorization signature of the Principal.
	Items marked with an asterisk (*) are required.

*Company Name:
*Customer Name:
*Customer e-mail:
Customer Code:
Master Account Code: (if applicable)
JHL Sales Branch:
JHL Inside Sales Representative:
*Request access level for this User ID (Check all that apply)
Account History:
Pricing and Availability:
Ordering:

	Click here to Print the form and have it signed and then return to:
	J.H. Larson Company Attn: MIS Department 10200 51st Ave N Plymouth, MN 55442	or fax to: J.H. Larson Company MIS Department 763-525-5884

Signature of Principal __________________________________________________ Date ______________ (For the release of information contained on the J.H. Larson Company ECSC)

You will receive your User ID and Password by e-mail. Please contact your J.H. Larson Sales or Customer Service Representative at your local branch office, or our MIS Department via e-mail at feedback@jhlarson.com

Click here to view an instruction sheet. Note you will need Adobe Reader to view the instructions. If you don't have Adobe Reader it can be downloaded by clicking here.

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