Imerge Partner Area - Register

Please register using the form below to set up login details for the partner area of this site.

Partner Area Access Request
Your Name*
Your email address*
same email address again*
Company*
Your phone number
Your town or city*
Country / State (USA only) *
About Me*
Please use this area to tell us why you want access
to the Imerge Partner Area.
Login Detail Requests
Please supply a username and password that you would like to use to log in to the site.

Important iconIMPORTANT! This password is low security: it will be passed over a non-secure link and may be emailed back to you un-encrypted if you request a reminder. Please DO NOT use the same password you use for secure transactions. The password should be at least 6 characters long and use a mix of letters and numbers.
User Name*
Password*
Password again*
Please check this box if you are not human.
*All asterisked fields are required. Please see also our privacy statement for information about how we use any data you supply.