New Account
New Account Set Up
Your User Information
This form is for registering a new company with SmartRequest or setting up electronic delivery for an existing Ciox customer. If you are a new user for an existing account, contact your administrator to get an account.
First Name
Last Name
Your Work Email
Verify Work Email
Work Phone Number
Title/Role (Optional)
If you are a current Ciox customer and receiving records via mail, please click here to enter your Customer ID and Invoice ID below.
Company Setup
Now provide us with information for your company profile.
Company Name
Company Phone Number
Company Fax Number
Company Address Line 1
Company Address Line 2
Company Address Line 3
City
State
ZIP Code
Business Type
Website (Optional)
Record Archival Period
The electronic data archive of any requested records can be saved for a set number of days. We provide 30 days for free, and can extend that period for a small fee per record.
Archival Service Selection
I understand the electronic data archival period begins when the record is available for download in Smart Request. This fee is in addition to the statutory requirement for record release.
Number of Days
Company Letterhead
Attach a copy of your company letterhead containing your company name, and address. To begin, “Select File” or drag and drop below
Version: 21ca3f72
Contact Us: 1-800-367-1500 ext 5