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Lexis Nexis Risk Solutions

Insurance Solutions - New User Request Form

User ID Request Form

Please enter all the information about the user you are requesting a User ID for below

Account Information
Agent Underwriter
User Information
Agency/Company Information

Agents please provide your agency's information. Underwriters, please provide your company information

IP Address Information

Please supply an IP Address or IP Address Range (below) for each physical locations

Only fill out one IP Address if you do not have a range assigned to you

Start IP Address End IP Address Action
Confirmation

I have read and agree to the terms of this document and hereby confirm that by marking the checkbox below, I have electronically signed this document. I understand that by inserting my electronic signature hereto, that I am legally bound by the terms and conditions of the form as if I had manually signed it.

By clicking this box: (a) I agree to the terms set forth in the above confirmation; and (b) I confirm that all information submitted by me is accurate and truthful.

Note: Upon receipt of this form by LexisNexis, you as User will be issued a User ID, which is your key to entry into the LexisNexis automated information systems. This USER ID is assigned ONLY TO YOU, and is NOT to be transferred, shared or used by anyone else , including, but not limited to anyone else within your business.

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