Apply for Portal Access

Agency Application

Complete this form to request access to the Blue Alpha Government Agency Quote Portal. We'll review your application and respond within 2 business days.

Company Information

Company / Agency Name *

EIN (Tax ID) *

State Tax Exemption Number *

Website

Tax Exemption Certificate * (PDF recommended)

📄

Click to upload your exemption certificate

PDF, JPG, or PNG · Max 10 MB

Shipping Address

Contact Name *

Contact Email *

Contact Phone *

Address Line 1 *

Address Line 2

City *

State *

Zip *

Billing Contact & Address

Same as shipping address

I confirm that the information provided in this application is accurate and complete to the best of my knowledge.