VIP Account Application Form



Welcome to the Daniel Royce VIP Customer Program.
We have come to realize that many of our valued customers are serious enthusiasts and hobbyists, with special needs and requirements. This program addresses many areas for you - the Customer, and aims at providing you with the lowest prices for our products, based on the quantity, frequency and longevity of your custom.

Benefits include:

To join the program now we invite you to submit your details and we will forward you further information with your personalized discount structures and benefits.
Please note that you need to provide valid email address in order to receive VIP Program information.



    Name
    Email Address
Make sure you provide correct email address.
    Password
    Verify Password
This password will be used to access your VIP
account and place online orders.
    Customer type
    Company
    Address 1
    Address 2
    City
    State
    ZIP (Postal Code)
    Country
    Website
    Phone
    Best Time to Call
    How did you hear about us
    Notes