Oregon Office of State Fire Marshal
CR2K Hazardous Substance Information Registration
(Fields with "*" are required entries)


* First Name
* Last Name
* Address
* City

* State (in USA or Canada)

  Country  (if not USA) 
* Zip (in USA)
(do not enter any punctuation)		  or Postal Code  (if not USA)
* Mailing Address
(must be a valid physical address)
* Mailing City
* Mailing State (in USA or Canada)  Country  (if not USA)
* Mailing Zip (in USA)
(do not enter any punctuation)		  or Postal Code  (if not USA)
* Phone Number
(10-digits, do not enter any punctuation)
* E-mail Address
(must be a valid address, 
 no Yahoo or Hotmail addresses will be accepted)
Business Name
Business Address
Business City
Business State  Country  (if not USA)
Business Zip (in USA)
  (do not enter any punctuation)		  or Postal Code  (if not USA)
Business Phone Number
(10-digits, do not enter any punctuation)
* Enter a Password
(please enter a 5 to 7 character password)
* Confirm Password