USER ID / PASSWORD REQUEST FORM

Step 1 - Please provide the UserID and password that you would like to use. The UserID must be from 4 to 10 characters. The password must be from 6 to 10 characters, including at least one letter and at least one number.

UserID:          Password:

Step 2 - Please provide the following information about yourself.
Name:	First:   Last:   Phone:
Agency:	ORI:   Unit:
	Not sure what the ORI number is for your agency? Contact your Agency CLETS Coordinator or call us at 916-227-3677.
Email:	Confirm Email:
	Please make sure your e-mail address is correct or we may not be able to process your request. That is the reason we ask you to confirm it by entering it twice.
Work Address:	City:
County:	Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba < Other   State:   Zip Code:
Comments:
	You will need to select a password reset question and answer below. This will help us verify you if we need to send you a password reminder.
Password Reset Question:	Name of your first pet First name of your first love Favorite color Model of first car Favorite sports team Favorite vegetable Favorite vacation spot   (Choose your question)
Password Reset Answer:

Step 3 - Submit your information by clicking the 'send' button below. You will be notified by email when your request has been processed.