NEW USER REGISTRATION
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1
Type
2
Information
3
Confirm
4
Finish
1. Registration Type
2. Tell us about yourself
3. Choose ID and Password
4. Tell us about your company
5. Billing
Are you registering a new business with us today?
:
YES (SELECTED)
Name
:
-- Select --
Mr
Ms
Mrs
Dr
Rev
Prefix
First
Middle (optional)
Last
Suffix (optional)
Street Address
:
Address
City
-- Select State --
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Utah
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Wyoming
District of Columbia
State / Province
-
Zip / Postal Code
Primary Phone
:
(
)
-
Birthday
:
-- Select --
January
February
March
April
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December
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-- Select --
2023
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1904
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1902
1901
1900
E-mail Address
:
Confirm E-mail Address
:
TERMS OF SERVICE
Terms of Service
:
Click here to view the Terms of Service
I have read and agree to the terms and conditions outlined in the Terms of Service
User ID
:
Password
Password is case sensitive
Password must be at least 8 characters long (no spaces)
Password must contain at least one digit
Password must contain at least one letter (upper or lower)
Password must contain one of these special characters ! * @ # $ % and ^
Password cannot contain any of these special characters ` < > " ' ; ( ) & + \ ? { } | ~ [ or ]
:
Password must meet the following requirements:
Be at least
8 characters
At least
one number
At least
one letter
At least
one
of the following special characters:
! * @ # $ % or ^
May
NOT
contain any of these characters:
` < > " ' ; ( ) & + \ ? { } | ~ [ or ]
Confirm Password
:
Password must meet the following requirements:
Must Match
Security Question
A security question is used as an extra layer of authentication to help keep your account secure.
:
-- Select Security Question --
What is your mother's maiden name?
What is the name of the company of your first job?
What is the street number of the house you grew up in?
What year did you graduate from high school?
Where would you most like to travel?
What is the name of your childhood hero?
Where did you meet your spouse?
Security Answer
:
Company Name
:
Business Name (DBA)
A Business Name (DBA - Doing Business As) is the name under which your business or operation is conducted and presented to the world. it is not the legal name of the legal person (or persons) who actually own it and are responsible for it.
:
Tax ID (FEIN) #
:
nine-digit number
Business Type
:
-- Select --
Dental
Optometry
Veterinary
Ophthalmology
Medical
Chiropractic
Pharmacy
Office
Copy Address
:
Street Address
:
Address
City
-- Select State --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
State / Province
-
Zip / Postal Code
California Employer Account Number
(optional)
:
County of Operation
:
Contact
:
E-mail Address
:
Phone
:
(
)
-
Who Referred You To Us?
(optional)
:
PACKAGE SELECTION
-- Select --
Start-up / De Novo
2022 Compliance Navigator 1 Location
2022 Compliance Navigator 2 Location
2022 Compliance Navigator 3 Location
2022 Compliance Navigator 4 Location
2022 Compliance Navigator 5 Location
2022 Compliance Navigator 6 Location
2022 Compliance Navigator 7 Location
Compliance Navigator Yearly
2021 Payroll Add On
Compliance Complete Sole Proprietor
HRFH 401k
2022 Compliance Navigator - Bronze
Package
:
Includes Payroll
:
Number of Employees
:
Setup Fee
:
Monthly Fee
:
Due at Signup
:
Process ID
:
for multiple IDs use the format
ID01, ID02, ID03
BILLING AGREEMENT
Billing Agreement
:
Click here to view the Billing Agreement
I have read and agree to the terms and conditions outlined in the Billing Agreement
Billing ID
:
Verification Code
The verification code is a test to ensure the response on this form is not generated by a computer. This is also known as a Captcha challenge response.
:
Retype Verification Code
: