EDEX Information Systems

If you are ready to open an EDEX Account...
To begin the process please complete the form below. If you select "Please open a new EDEX account for us..." on the application below we activate your service as quickly as possible. Please be sure to list a valid phone number so we can contact you to complete the activation process.

Not quite ready to open an account? That's fine, too...
Many of our customers have questions about EDEX or need other assistance prior to opening an account. We're always happy to help answer your questions. Complete the form below and select "Please contact us with more information about EDEX..." and a Account Manager will contact you shortly to answer your questions.

INSTRUCTIONS: Complete the form below and click the "Submit" button. The form below will be submitted to our office electronically and a confirmation notice will be delivered to the e-mail address you provide.

Once your information below is received in our office an Account Manager will contact you to answer your questions and activate an account for you if you desire. Our Account Management staff is available Monday through Thursday from 8:30am-5pm and on Friday from 8:30am-4pm. Applications submitted after hours or on weekends/holidays will be received by the Account Management staff the following business day.

Special For Credit Card Accounts! Save $50 off the activation fee if you choose to pay your monthly account charges by credit card. Ask for details about AutoPay™ when you activate your account!

Are you Ready to Open an EDEX account?:
Company Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Contact Person:
Phone:	(123) 456-7890
Fax:	(123) 456-7890
E-Mail Address:
Nature of Business:
Business Type:	Case Party (Insurer, Attorney, etc.) Lien Claimaint (Doctor, Hospital, etc.) Other (Employment Screening, Investigators, etc.)
Briefly describe why you need EDEX access:
Please tell us how you heard about us. If you were referred by one of our many clients please let us know who to thank!:
Thank you for choosing EDEX Information Systems A member of our Customer Care team will contact you shortly to complete the application process or answer any questions you may have about using EDEX.

Copyright © EDEX Information Systems, Inc.
All rights reserved. Improper use or distribution of data or account information is strictly prohibited.
EDEXIS and the EDEX logo are trademarks of EDEX Information Systems, Inc.