Register to use CIANet

	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*:
Fax:
Email 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. Multiple Users - I will be able to see my own claims, as well as those of one or more other users identified below (for Supervisors or Team Leaders with appropriate approval). Single Location -- I will be able to see all claims submitted for the above address Multiple Locations -- I will be able to see all claims submitted for the above address and the locations indicated below. All Locations -- I will be able to see all claims for all locations associated with my company.
**Additional users or locations-- Please provide the complete address of each additional location or the names of additional users that you are requesting in the box below. For additional locations, please also provide the CIA Customer Number (if known):
Manager's name*:
Manager's email*:
Manager's phone*:
COMMENTS:
Please click the submit button only once. The system will display a confirmation page once your registration has been completed and you will receive a system generated confirmation that we have receieved your registration.