AGENCY - Create Account

Create Account

1 Account
2 Plan
3 Vehicle
4 Tag
5 Additional Information
6 Billing Information
7 Thank You

Personal Details

Account Type

Business Name

Title

Suffix

First Name

Middle Initial

Last Name

Address Details

Address Line 1

Address Line 2

Address Line 3

City

State

Zip

Country

Contact Details

Primary Email

Is Preferred? ?

Secondary Email

Is Preferred? ?

Day Phone #

Is Preferred? ?

Evening Phone #

Is Preferred? ?

Mobile Phone #

Is Preferred? ?

Work Phone #

Is Preferred? ?

Fax

Security Details

Username

Password

Retype Password

I agree to the Terms and Conditions

Cancel

Enter all mandatory fields

Step 1

Account Information

This information is necessary to get an account with CCRMA

Step 2

Add Plan

Customer has to select the replenishment type to proceed.

Step 3

Add Vehicles

Customer has to add the vehicles online by entering all the mandatory fields.

Step 4

Add Tag

Tag Request is mandatory for individual customers. For business customers, it is optional.

Step 5

Additional Information

The preview displays all the information provided for creating an account.You can modify your details at any point of time by going back to the previous pages.

Step 6

Billing Information

CCRMA provides Card as payment mode. Provide the payment details to make a payment