InterLink

User Self Registration Form

Company Information

Company Name*:

Postal Code:

Address* :

Phone*:

City*:

Fax:

State/Province/Region*:

Role*:

Country*:

Buyer/Retailer Company Name*:

User Information

First Name*:

Title:

Last Name*:

Phone*:

Email Address:*

Mobile Phone:

Department:

Access Requested

Note: Access may be subject to Retailer or Portal Owner’s approval. Please allow up to 2 business days for full user access to be configured.
Interlink Module (* Please select at least one)
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* Enter text as seen in above image (case sensitive):

Send Confirmation Email to Intertek Account Manager or Representative:

(Leave Confirmation Email blank if you do not have an Intertek Account Manager)

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