Customer Registration

First Name:

Last Name:

Company Name:

Email Address: (This will be your username)

In order to avoid delays in order preparation, please enter a valid email address.

Password:

Verify password:

The passwords must match.

Street Address:

Street Address (continued):

Apartment/Suite:

City:

State:

Zip Code:

Telephone:

Birthday:

Opt-in to receive promotions from Shangri-La - Birmingham:

Fields marked with an * are required.

Open

Pickup

Monday: 11:00AM - 2:30PM 4:30PM - 9:00PM

Delivery

Monday: 4:30PM - 9:00PM