Welcome to the Customer Portal Access Request Form. Please complete the information below so that your request may be processed within 7 business days. Once the set-up is completed you will receive an email containing your Customer Portal login information.

Note: If your company is already set up on the Customer Portal your request will be forwarded to your Company Site Administrator to process your request.

Note: Asterisk (*) denotes a required field.

Are you currently purchasing directly from Kimberly-Clark?   Yes   No

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Customer Portal access is not available. Please contact your distributor to find out what online options are available or get product information from www.kcprofessional.com

Company Site Administrator � We know the security of your data is important and the Site Administrator allows you complete control over who has access to your data. If you are requesting access and your company is not setup already , you will be given the access of Site Administrator. Each company is required to have at least one Site Administrator who will add/remove users to the Customer portal and provide access to the areas specific to the users you set up. The Site Administrator role enables you to manage who should have access to your information on the Customer Portal.

Customer Portal Requestor Information:

Your First Name: *
Your Last Name: *
Your Title: *
Your E-mail Address: *
Your Telephone Number: * Ext

Distributor Information:

Distributor Name: *
Distributor Number: 
Distributor Street Address: *
Distributor City: *
Distributor State/Province: *
Distributor Zip/Postal:  *
Distributor Country: *
Distributor Telephone Number:  *

Are there other locations that may be interested in the Customer Portal?
Customer Name:Address:City:State:Zip/Postal:

Please select the areas of the Customer Portal you would like access to:

Product Catalog
Order Management
Invoice Management
Price Agreement Management
Chargeback Coupon Management

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