Customer Registration

Customer Support Portal – New User Registration

Please fill in the fields below. Required fields are marked with an asterisk (*). Your ActiveCare maintenance contract includes your company’s login credentials.



Please fill in the fields below. Required fields are marked with an asterisk (*). Your ActiveCare maintenance contract includes your company’s login credentials.

Company Information

ActiveCare Username / Customer ID*


:
ActiveCare Password / Entitlement ID*


:

Individual Information

Email Address*


:
Salutation*


:
First Name*:
Last Name*:
Department:
Job Title


:
Main Phone*:
Mobile Phone:
Entitlement Admin


: