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Important: Please read

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To Expediate your application, please send an application fee with a check payable to MICCS($450 for MICCS members, $600 for nonmembers) to:

MICCS
7439 Woodland Drive
Indianapolis, IN 46278

If a check is not received within 60 days of submitting this application, the application will be deleted from the system.


Company Application : Part 1 of 3

Below is part 1 of 3 of the online Company Application. You must complete Part 1 to obtain a username and password into the system. After you complete and save Part 1 of the application, you may exit the system or continue with the application. If you exit the system, you can obtain access to your application by logging in using the username and password you just created.



Company Information


Company Name*

Address 1*

Address 2

Address 3

City*

State*

Zip Code*

Country*

Phone*

Fax

Website Address

Do you wish other participating contractors to be able to view your company data?*

Yes: No:

Important note: By submitting this application, the contractor agrees that all information related to the contractor's participation in the Safety Certification Program will be posted on the MICCS Certification Web site for review by owner companies. Information related to who has access to such information can be found in the Instruction Guide.

Contact Information

Person to be contacted for all matters pertaining to MICCS Certification:

Prefix

First Name*

Middle Name

Last Name*

Suffix

Title*

Email*

Date Submitted

Login Information

Please make note of your username and password after entering values into those fields:

Create User Name *

(first initial, last name, i.e. jsmith)

Create Password*

Retype password *