CIANet Registration

CIANet User Registration

To become a registered user of CIANet, you must be an existing CIA customer. Upon approval of your registration submission, a confirmation will be sent to your e-mail address (provided below) that contains your new username and temporary password. Upon your first Sign In you will be requested to change your temporary password to a unique permanent password of your choice.

USER/CUSTOMER INFORMATION:

(Required fields are marked with a * ).

First Name:*

Last Name:*

Title:

Company Name:*

CIA Customer #
(optional):

Street Address:*

Street Address (cont):

City:*

State/Province:*

Zip/Postal Code:*

Phone:*

( )

Ext. #: (optional)

Fax:

( )

E-mail Address:*

CUSTOMER LOCATION VIEW OPTIONS: (Choose one)

Note - the address shown above will be considered your primary (default) location. Additional locations
must be added below.

All options require management approval.

Single User Only - I will only be able to see my own claims.

Single Location - I will be able to see all claims submtted for the above address.

Multiple Locations - I will be able to see all claims submitted for the above address, as well as the additional locations shown below.**

All Locations - I will be able to see all claims for all locations associated with my company.

**Additional Locations -
Please provide the complete address of each additional location that you are requesting in the box below. Please also provide the CIA Customer Number (if known):

Manager's Name:*
Manager's E-mail:*
Manager's Phone:*

COMMENTS:

Please click the Submit button only ONCE. It may take a few minutes for your page to be processed. A confirmation page will appear once your registration has been sent.


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