•  Indicates Required Fields
Create Your Account /This Is Required For Future Login
 •  E-Mail address
 •  Choose a Password
 •  Verify your Password
(Enter 5-20 Characters / Password is case sensitive)

Billing Address
 • First Name
  Mi 
 • Last Name
 •  Company / Institution Name
 • Address - Line 1
Address - Line 2
 • City
 • Country
 •  Contact Tel Number
Company / Institution Phone Number Ext:
Fax Number
Company Website URL:
Payment Method
SS# / Tax ID
Checks Payable to
Paypal Account

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Double Diamond Tack
PO Box 356
Leesburg, IN 46538
United States
Ph: 800-814-3144
eMail: Jana@DoubleDiamond.org
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