COBRA Administration Manager

Lights! Camera! Action!

Watch a short video detailing the COBRA Admin. Mgr.

COBRA Companion

New User Registration

Contact Information:

Please complete the form below with your company information. This information is used for billing and ensuring that you are a current COBRA Administration Manager user. If you are not currently a user of the COBRA Administration Manager, please click here for purchasing information.

Name:
Company Name:
Street Address:
City:
State:
Zip:
Phone:
Email Address:
Current COBRA Administration Manager User Name (optional):

Credentials:

The user name and password created here will be used to access your account via www.mytpaonline.com. The email address you enter here is displayed to the groups that you setup through COBRA Companion. It may be the same as above or you may want to use a different email address. All information may be changed from your control panel.

Note: User Name and password may be altered by COBRA solutions. Once your account has been created, your credentials will be emailed to you.

User Name:	(Must be between 8-12 characters)
Password:	(Must be between 8-12 characters)
Confirm Password:	(re-type password)
Email Address:

First year account set up fee:

Initial Setup fee ($50 plus pro-rated annual fee):

$ 157.50

Service Agreement:

Before submitting this form, please review the following Service Agreements. After reviewing, check the boxes indicating that you agree with our service agreement.

	Master Agreement
	Service Agreement