common header
/WebContent/common/includes/header.jsp
registration
/WebContent/ebt/security/registerNewUser.jsp
For questions about registration, call 877-277-7270.
Please allow up to three business days for user account authorization. An Electronic Services Agreement must be on file for your office before access can be authorized. If this is a new office registering, your account may be deleted in 30 days if we have not received the required Service Agreement. Please call to verify if this is on file.
First name The first name is required.
Last name The last name is required.
E-mail address (optional)
Office's Tax ID# (TIN) The Tax ID is required and must be numeric only.
Username The username is required.
Mother's maiden name Mother's maiden name is required.
I agree to abide by the Terms of use. Agreement to Terms of use is required.
common footer
/WebContent/common/includes/footer.jsp