Eagle Island Publishing

Advertiser Account Registration

Please fill in the registration form below to create your advertiser account:

You MUST have a valid Rep Code to create your account. Please contact us directly to get a valid Rep Code PRIOR to filling your registration form out. You will not be able to complete your registration without a valid Rep Code.

Company Name

Please enter a Company Name.

First Name

Please enter a First Name.

Last Name

Please enter a Last Name.

Rep Code

Please contact us to get a valid a Rep Code.

Address

Please provide an address.

City

Please provide a valid city.

State

Please select a valid state.

Zip

Please provide a valid zip.

Company Phone

Please enter a Company Phone.

Cell Phone

Email Address

Please enter a valid Email Address.

Password

Strong Password!

At least 8 characters, one number, one special character, one capital letter and one lower case letter

I have read, understand, and agree to the Terms & Conditions.

Your password must be 8-20 characters long, and must contain one special character "!@#$%&*_?.", one number, and both lower and upper case letters.

Please verify that you are not a robot.