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Create your Kiwi site address

Every Kiwi site has its own unique web address. This is where you'll login. For example, if you wanted your kiwi site to be at pedorthist.kiwi.com you'd enter pedorthist in the field below. Letters and numbers only - no spaces.

Account *

http:// account.kiwilabservices.com

Create your administrator account

Username *

First Name *

Last Name *

Email*

Desired Password

Password (Again)

Client or Company Name

Company Short Name

This variation of your company name will be used in situations where your company name needs to fit into an area of limited size, for example on the reports which are emailed out to patients (maximum 25 characters)

Phone Number *

Billing Address

Address *

City *

Postal Code *

Province / State *

Country *

Phone Number *

Billing Information (secure):

All prices are in Canadian Dollars.

Credit Card Type *

Credit Card Number *

Expiry Date (mm/yy)*

Cardholder Name *

Your credit card will not be charged