Don Felipe's Salsa

Registration Form

Every new customer making an online purchase is required to fill out the registration form below. Registered users must be at least 18 years of age.

Please choose a Login Name and Password. You will be able to use this name and password next time you come to our site.

Login Name: (The login name should be at least 8 characters with no spaces between the characters. Your email address would make a good login name for your account.) Do not use spaces, slashes, &, , or apostrophes in your login name or password.
Password: (The password should be between 8 and 25 characters with no spaces between the characters.)*

Please provide the following information. The information is for our internal purposes only and we we will not share this information with anyone else.

*First Name:	*Last Name:
Company:
*Street:	Apt.#:
*City:	*State:	*Zip Code:
E-Mail Address:
Telephone: - x (Area Code - Phone Number X Extension)
Check this box if you would like to recieve Specials, Updates and Product Announcements via email.
Please verify all the information before you continue. By submitting this information you certify that it is correct.

PO Box 6192 Elizabethtown, KY 42702 Phone: (888) 773-5425