register a new user

* required fields

billing information
user name
*  
password
*  
confirm password
*  
first name
*  
last name
*  
company
address
*  
city
*  
state
zip code
*  
country
phone
fax
email
*  
shipping information
shipping first name
shipping last name
shipping company
shipping address
shipping city
shipping state
shipping zip
shipping country
shipping phone
shipping fax