portal.ccspr.net
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52.177.141.147
Public Scan
URL:
https://portal.ccspr.net/Register
Submission: On February 28 via manual from IN — Scanned from DE
Submission: On February 28 via manual from IN — Scanned from DE
Form analysis
2 forms found in the DOMPOST /Register/RegisterCarrierUser
<form method="post" action="/Register/RegisterCarrierUser" novalidate="novalidate">
<h4>Register a carrier user.</h4>
<hr>
<div class="text-danger validation-summary-valid" data-valmsg-summary="true">
<ul>
<li style="display:none"></li>
</ul>
</div>
<div class="form-group">
<label for="FirstName">First Name</label>
<input class="form-control" type="text" data-val="true" data-val-required="The First Name field is required." id="FirstName" name="FirstName" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="FirstName" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="LastName">Last Name</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Last Name field is required." id="LastName" name="LastName" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="LastName" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="CarrierName">Carrier Name</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Carrier Name field is required." id="CarrierName" name="CarrierName" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="CarrierName" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="Department">Department</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Department field is required." id="Department" name="Department" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="Department" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="WorkLocation">Work Location</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Work Location field is required." id="WorkLocation" name="WorkLocation" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="WorkLocation" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="PhoneNumber">Phone Number</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Phone Number field is required." id="PhoneNumber" name="PhoneNumber" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="PhoneNumber" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="Email">Email</label>
<input class="form-control" type="email" data-val="true" data-val-email="The Email field is not a valid e-mail address." data-val-required="The Email field is required." id="Email" name="Email" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="Email" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="Password">Password</label>
<input class="form-control" type="password" data-val="true" data-val-length="The Password must be at least 6 and at max 100 characters long." data-val-length-max="100" data-val-length-min="6" data-val-required="The Password field is required."
id="Password" name="Password">
<span class="text-danger field-validation-valid" data-valmsg-for="Password" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="ConfirmPassword">Confirm password</label>
<input class="form-control" type="password" data-val="true" data-val-equalto="The password and confirmation password do not match." data-val-equalto-other="*.Password" id="ConfirmPassword" name="ConfirmPassword">
<span class="text-danger field-validation-valid" data-valmsg-for="ConfirmPassword" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<input id="g-recaptcha-response" name="g-recaptcha-response" type="hidden"
value="03AFY_a8UmdT2h0OxiERGBIEQTKvpfnC18SnO28j0A0P3QPyhgJILMndegcExZ0p53Jh84M3Sj2qqEFYI71fgSBRDb9OK5TaduX-9u21Vzu-N68uxR1WsFbips9K-8kgCevUywlFb7L95D4sF-EoNWmkSxU5WjD61bEqGUo_Vqmx9bmMZE493Jvqg7TiJeirspMPGFQCDcvuxqBFi4LCi44XGCYbXpOKTrZs1u9NFcRxdnGjjAslAxLwohstrWvvQx-liowj-uYhoAi9DEcvX67Do_5UnMK6Dcwc9QCIXLyAT918XHSmO9BNCybfb3-Ctm2ocaIPsi8IF-zI9Nnf5F-Iisl_ca5OE7XEsc1dzpHePDufS3b60hPNOul_oCYOQp2_eHu8nOpbQha90a6WE3J6ZXKeJt0W5H09aGDKmff3LZxaCGo_Pzg8n2hvXqgyiCJ7Oma7GKLRmXVez3ppZQnr1ddrzFr4V_zVR_uCjPH_ZlOI-9AKw43MvoZvORZDHBcX54c4ERlQJinl9Ds80uyzshG1afSoP3JA">
<script src="https://www.google.com/recaptcha/api.js?render=6LcP36MZAAAAAEhNG1ClWmO2TsV87_47G55yRWs5&hl=en"></script>
<script>
if (typeof grecaptcha !== 'undefined') {
grecaptcha.ready(function() {
grecaptcha.execute('6LcP36MZAAAAAEhNG1ClWmO2TsV87_47G55yRWs5', {
'action': 'homepage'
}).then(function(token) {
document.getElementById('g-recaptcha-response').value = token;
});
});
}
</script>
</div>
<button id="recaptcha" type="submit" class="btn btn-default">Register Carrier</button>
<br>
<small> This site is protected by reCAPTCHA and the Google <a href="https://policies.google.com/privacy">Privacy Policy</a> and <a href="https://policies.google.com/terms">Terms of Service</a> apply. </small>
<input name="__RequestVerificationToken" type="hidden" value="CfDJ8L2YMwsi8L5Jq12oAXJZ0U2YYT8LZVGLq7o-Q_T7pvzZUQOP7I7TbhYhk_zF95PUZAZeKUdO3mL08VyVUS_YxC364WOY00eR1CasS9vjh2GqHt5RpINXrEH3Mpxyif1OkR05oJzf6mNHay55SQHr4CQ">
</form>
POST /Register/RegisterCustomerUser
<form method="post" action="/Register/RegisterCustomerUser" novalidate="novalidate">
<h4>Register a customer user.</h4>
<hr>
<div class="text-danger validation-summary-valid" data-valmsg-summary="true">
<ul>
<li style="display:none"></li>
</ul>
</div>
<div class="form-group">
<label for="FirstName">First Name</label>
<input class="form-control" type="text" data-val="true" data-val-required="The First Name field is required." id="FirstName_c" name="FirstName" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="FirstName_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="LastName">Last Name</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Last Name field is required." id="LastName_c" name="LastName" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="LastName_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="CcsAccountNumber">CCS Account Number</label>
<input class="form-control" type="text" data-val="true" data-val-required="The CCS Account Number field is required." id="CcsAccountNumber_c" name="CcsAccountNumber" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="CcsAccountNumber_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="BusinessName">Business Name</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Business Name field is required." id="BusinessName_c" name="BusinessName" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="BusinessName_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="Address">Address 1</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Address 1 field is required." id="Address_c" name="Address" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="Address_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="Address2">Address 2</label>
<input class="form-control" placeholder="Optional" type="text" id="Address2_c" name="Address2" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="Address2_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="City">City</label>
<input class="form-control" type="text" data-val="true" data-val-required="The City field is required." id="City_c" name="City" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="City_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="State">State Province</label>
<input class="form-control" type="text" data-val="true" data-val-required="The State Province field is required." id="State_c" name="State" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="State_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="ZipCode">Postal Code</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Postal Code field is required." id="ZipCode_c" name="ZipCode" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="ZipCode_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="Country">Country</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Country field is required." id="Country_c" name="Country" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="Country_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="PhoneNumber">Phone Number</label>
<input class="form-control" type="text" data-val="true" data-val-required="The Phone Number field is required." id="PhoneNumber_c" name="PhoneNumber" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="PhoneNumber_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="Email">Email</label>
<input class="form-control" type="email" data-val="true" data-val-email="The Email field is not a valid e-mail address." data-val-required="The Email field is required." id="Email_c" name="Email" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="Email_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="Password">Password</label>
<input class="form-control" type="password" data-val="true" data-val-length="The Password must be at least 6 and at max 100 characters long." data-val-length-max="100" data-val-length-min="6" data-val-required="The Password field is required."
id="Password_c" name="Password">
<span class="text-danger field-validation-valid" data-valmsg-for="Password_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<label for="ConfirmPassword">Confirm password</label>
<input class="form-control" type="password" data-val="true" data-val-equalto="The password and confirmation password do not match." data-val-equalto-other="*.Password" id="ConfirmPassword_c" name="ConfirmPassword">
<span class="text-danger field-validation-valid" data-valmsg-for="ConfirmPassword_c" data-valmsg-replace="true"></span>
</div>
<div class="form-group">
<input id="g-recaptcha-response_c" name="g-recaptcha-response_c" type="hidden"
value="03AFY_a8V3XlswRPriRadH7ceWqqE6A5t8DBhJyXPa1YqrvVg-Cov45eHZ9RQ8JwnwHVV79pq2-d8kRG-Vd7c_DXrFpJI7OgoquzEa8Dr_UPAJzzgGWYIMF53pwocboBZT4Gzwg0TPHtYdBKlqd7ckU62YnPZZZw-J1ObYzsiz7QcCdsR5j2E4CETdu6sR4zZ8JRsulG8REqh89D3OWxTleKecIR8Db7bTQqPV0SA7dCvytfPGbSxQieb8zTYIKwk7YRLqVck1H6TcPvUEMh68veEqOrExFhoJ7rnGvVR0l0dsP441k71thiez5onc95EB35sVS5DHGFadr8awxwnqBEM_Z10231-gcUnZ-Wy4YziImwFjj-WQXndnAqQ4YntiVzT-voTzhYPxWqr9yQgSfmnEz-wfLNSlPgL-vR-1-Hc2ZykcdptYum3aQOazVPQ4APZaZbek0bpmdkH8g7rU683wgesd9_E5UPsLIBeEoivPMmxcxBy6oEl9JOhwdtlyNcBamUGUnqOFyb6PH80JalEwfn-2EjytQA">
<script src="https://www.google.com/recaptcha/api.js?render=6LcP36MZAAAAAEhNG1ClWmO2TsV87_47G55yRWs5&hl=en"></script>
<script>
if (typeof grecaptcha !== 'undefined') {
grecaptcha.ready(function() {
grecaptcha.execute('6LcP36MZAAAAAEhNG1ClWmO2TsV87_47G55yRWs5', {
'action': 'homepage'
}).then(function(token) {
document.getElementById('g-recaptcha-response_c').value = token;
});
});
}
</script>
</div>
<button id="recaptcha_c" type="submit" class="btn btn-default">Register Customer</button>
<br>
<small> This site is protected by reCAPTCHA and the Google <a href="https://policies.google.com/privacy">Privacy Policy</a> and <a href="https://policies.google.com/terms">Terms of Service</a> apply. </small>
<input name="__RequestVerificationToken" type="hidden" value="CfDJ8L2YMwsi8L5Jq12oAXJZ0U2YYT8LZVGLq7o-Q_T7pvzZUQOP7I7TbhYhk_zF95PUZAZeKUdO3mL08VyVUS_YxC364WOY00eR1CasS9vjh2GqHt5RpINXrEH3Mpxyif1OkR05oJzf6mNHay55SQHr4CQ">
</form>
Text Content
INVOICE MANAGEMENT SYSTEM: REGISTER Register as a Customer. All other entities please contact your CCS representative. None Customer Note the following: 1. The registration process must be completed within two minutes. 2. Once the registration is succesful, it can take up to 48 hours for the approval process to be completed. REGISTER A CARRIER USER. -------------------------------------------------------------------------------- * First Name Last Name Carrier Name Department Work Location Phone Number Email Password Confirm password Register Carrier This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. REGISTER A CUSTOMER USER. -------------------------------------------------------------------------------- * First Name Last Name CCS Account Number Business Name Address 1 Address 2 City State Province Postal Code Country Phone Number Email Password Confirm password Register Customer This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 2023 © Carrier Credit Services About Services Contact Privacy Policy Terms Of Service