CCI Xpress / Acct Request Form

Please complete the information below and click "SUBMIT".
You will be notified by CCI within 2 business days with your log-in and password
If you have questions, please call your Customer Service Rep at CCI 800-323-9355

*required Field
*Company Name(legal name as it would appear on credit app) Acct#(if you know - but not required)
*First Name *Last Name
*Job Title
*Email Address
*Confirm Email Address
*Street Address(Ship to address - Not Billing Address)
*City *State *Zip
*Phone #
*PO #