4/29/2024
MASTER WEB ADMINISTRATOR ACCOUNT APPLICATION
AUTHORIZATION
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Applicant Name :
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Applicant Title :
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Date :
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I hereby certify that I have been authorized to perform the duties of the Master Web Account Administrator for this agency by the following President, Owner, or Officer of the organization.
Authorized By:
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Last Name :
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First Name :
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Title :
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Date :
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Email Address :
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I hereby certify that I am eligible for a Web Administrator User Account and I am a current employee of an Agency or Premium Finance Company licensed in North Carolina.
By submitting your Master Web Administrator application you are hereby accepting the Terms of Use/Privacy Policy on behalf of your company (ies). Upon your first login to our web portal you will be prompted to formally accept the Terms of Use/Privacy Policy as an individual User of our applications.
To submit this form, please click the "I'm not a robot" checkbox below. Follow any additional instructions if provided. After successfully completing the verification you can continue by clicking Submit.
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Mandatory Fields
2910 Sumner Boulevard, Raleigh, NC 27616 Phone: (919) 783-9790 www.ncrb.org
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