Create New Customer Profile


The form below allows you to create a profile which is necessary to place orders. Do not forget that this information is essential to use our services correctly.

Personal information
First Name *
Last Name *
Name of friend that referred you (if applicable)?  
How did you hear about FarmBox Delivery?  
Can we SMS text you important notifications about your orders and account?  
Billing Address
Address *
Address (line 2)  
City *
State *
Zip/Postal code *
Delivery Address
Click here if Delivery Address is different from Billing Address  
Delivery Address (leave empty if same as billing address)
Address (line 2)  
Zip/Postal code  
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Contact Information
Phone *
E-Mail *
Confirm email *
Username & Password
Username *
Password *
Confirm Password *
Birthday    Reset
Miscellaneous options

Never List

(If you don't like certain items, choose from this list and we'll do our best to accommodate)

Payment information
Payment method *
Click to enter your credit card details

Enter Credit Card Details

Credit card number (no spaces or dashes) * You have not entered your payment details yet...
Discount coupon
Coupon Code  

Additional Information

Additional information
Are you in a gated community or apartment complex? If so, please list gate code:  
Is your box delivery location a business? If so, please list instructions for entrance and hours of operation. ($5 will be applied per delivery)  
Anything special you think our team and/or driver should know?  
Would you be interested in becoming an ambassador and promoting FarmBox Delivery?  

Enter the letters/numbers you see in the image: