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Provider Registration *=Required
Enter your Provider Identification, User Access information and click Continue to begin the online
registration process.
Provider Identification
*FIS Provider ID:
*Provider Phone # : - -
*State or Program:
*Last 4 digits of Provider's Bank Account # : Help?      
Only used in adding an additional User ID and will gray out after choosing a
"Program" in the above drop-down box.
User Access
*User ID:
(User ID must be an email address;
sample: John_Doe@provider.com)
*Re-enter User ID:
*Password:
(Passwords must be at least 8 characters but no more than 14 characters long
and must contain at least 1 number, at least 1 lower case and at least 1 upper case letter)
*Confirm Password:
*Challenge Question 1:
*Challenge Response 1:
*Challenge Question 2:
*Challenge Response 2:
*Challenge Question 3:
*Challenge Response 3:
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* Enter the text shown above :
  
Note: If you have questions or experience problems with the registration process, call 1-800-894-0050.
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