9-1-1 Service Fee Remittance Registration

Organization Information

Please provide us with the following information about your organization.

All fields are required.

Company/Organization Name Required Taxpayer Identification Number (TIN) Required Phone Number Required

Address Required City Required State Required Zip Code Required

Remitter Contact Information

Please provide us with your contact information.

All fields are required.

First Name Required Last Name Required Title Required

Email Address Required The email address entered is not valid. Phone Number Required

Payment Information

Please provide us with your desired payment schedule and method.

All fields are required.

Payment Schedule Required

Payment Method Required

Service Information

Please identify the type of service you provide in any of the GCRECD's eight county region (Brazoira, Chambers, Colorado, Liberty, Matagorda, Walker, Waller, Wharton):

VOIP Service

Wireless Service

Wireline Service

Are you a reseller?

Login Information

The 9-1-1 Service Fee online payment form will require you to log in to submit a payment on behalf of your organization.

Please create a password to use. This password will be used with your Taxpayer Identification Number (TIN) to log into the 9-1-1 Service Fee online payment form.

Passwords must be at least 8 characters long, and contain at least 1 letter and 1 number.

Password Required

Please enter your password again to verify Required Passwords do not match.

Required

Duplicate TIN

It appears that then TIN you entered is already registered with an account. If you believe this to be an error, please contact us at [email protected].