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   Credit card
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: