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Wednesday, April 24, 2024

Invalid User ID or Password.

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 between 8 and 14 characters long and must contain at least 1 number,
	1 lower case letter and 1 upper case letter, with no special characters. The password may also have up to a maximum of 3 repeating characters.)

*Confirm Password:

*Challenge Question 1:

*Challenge Response 1:

*Challenge Question 2:

*Challenge Response 2:

*Challenge Question 3:

*Challenge Response 3:

* Enter the text shown above :

Note: If you have questions or experience problems with the registration process, call null

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