Registration Form
A $21.00 per certificate fee for this service payable by credit card only to CertFocus. Please review insurance requirements outlined in the Agreement and Rules and Regulations to assure your COI meets all mandatory requirements. If your COI does not meet the requirements, you may be charged another fee when uploading a corrected COI.

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Account Information (contact person)

First Name 
Last Name 
Email Address 
Confirm Email Address 
Create Password
   
Confirm this Password by Typing it Again

Company Information

Company Name 
Address 
Address 2
City 
State 
Zip Code 
Phone 
Fax
Tax ID   What is this?
Exhibitor and Booth Number  

Insurance Agency Information   Why?

You may utilize more than one insurance agent to provide all your certificates of insurance.

Payment Information

Name on Card 
Card Type 
Card Number 
Expire Month 
 
Expire Year 
Address is the Same As Above
Billing Address 
Billing City 
Billing State 
Billing Zip Code 
Billing Phone 
All fees associated with the submission of compliant documents will be billed to the credit card on file.