ILTPP New User Registration Request

Please enter the information below to request new user registration. All fields are required.


Name and School
Name of person placing orders on behalf of this school through the ILTPP website.
First Name:
Last Name:
Organization Type:
School or Facility:
Tax Exempt Number:
Your Billing Address 
as you want it to appear on your order
School Address:
City:
County:
Zip Code:
Email and Phone Number
Email order confirmations to this address
Email Address:
Phone Number:
Fax Number:
How did
you hear
about us?
Authorization Information
You must provide the name and email address of the person responsible for allocating funds for this entity (i.e., Superintendent, principal, direcotr, etc.)
First Name:
Middle Initial:
Last Name:
Email Address:
Signature: ______________________________________________________________
of the authorized person
Account Password
This is the password you want to use to access your account. Maximum 30 characters.
Password:

* All fields are required to complete registration.

1. Prior to clicking the 'Submit Request' button, please PRINT THIS FORM, have it signed by the authorized person within your school/district (i.e., Superintendent, principal, director, etc.) and fax the signed copy to (217) 893-0024, or scan and email to or mail to

ILTPP
Karen Mueller
200 S. Fredrick, Suite 202
Rantoul, IL 61866

2. Once the form has been printed, please click the 'Submit Request' button. (A signed contract is required before orders can be accepted. Your user application will not be approved until we receive a signed contract.)

© 2013 Illinois Learning Technology Purchase Program