LifeConEx User ID Request Form

User ID Request Form

	UID *
		UID is case sensitive and must be between 4-8 characters
	Password *
	First Name */ Middle Init.
	Last Name *
	Job Title *
	Email Address *
	Phone Number *
	Fax Number *
	Company Name *
	Address
	City
	State
	Zip
	Country

	Parent Company Name(If Different):
	Address
	City
	State
	Zip
	Country
	Relationship with Parent Company
	DHL Global Forwarding Contact

* FIELDS ARE REQUIRED

Once you are registered, the user account administrator will assign you the access level. Your account will be activated as soon as the access level is set. This process might take three working days or longer.