Contact Us
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info@chartswap.com
Records Requestor Registration
We just need a bit of information to get you and your organization set-up to start using ChartSwap
Requestor Information
Company Type
Law Firm
Insurance Company
Record Retrieval Company
Other
Company Name
Address
Attention
City
State
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Phone
Fax
How did you hear about us?
Email from ChartSwap
Letter from Provider
Letter from Requestor
Smart Request Referral
User Information
First Name
Last Name
Email
(Email address will be your Chartswap Username)
Phone
Register