Registration Form (please note that the field with bold label is required)  
Agency:
Company Name/Legal Entity Name:
Address:
Address Contd:
Country:     
City:
Zip:  
Tax Payer ID:
Phone:
(111)123-4567 / with ext. (111)123-4567-890
Alternate Phone:  
Fax:
State Employer ID:
State License Board No.:
Workers Comp Carrier:
Doing Business As:
 
Contact Information

Last Name:
First Name:
Title:
Direct Phone:
Cell Phone:
Email Address:
 
Company Information

Business Structure:


Business Type:
 
 
Certified Information

Is Your Company DBE, MBE or WBE Certified?
CUCP Verification:
Enter FirmID : 
 
  
Ownership Code:
 
Your User Name and Password

User Name:
Password:  
Confirm Password:    
Security Question:  
Security Answer:  

 Refresh

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TRS System

Version: 1.0.0.0 APP10