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Sign Up for a New Third Party Administrators' Account

  • STEP 1:
    Address and Contact
  • STEP 2:
    Payment

Use the form below to register for a new Standard Directory of Third Party Administrators account. If you have any questions you may also contact a sales representative at 800-231-0669.

Enter Your Address and Contact Information:

NOTE: You must enter a valid e-mail address so that we can e-mail you your password.

All fields in red are required.

First Name:
Last Name:
Title:
Company:
Street Address:
Suite:
City:
State: Req for U.S. Address Only
Zip/Postal Code:
Country:
Phone  
Fax:
Email:  




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