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Set Up a New Account
* This Field is required Required field | Information for: ? : Field description: Move mouse over icon Information: Point mouse to icon
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Your account can be setup here online or if you prefer call us at 615-833-6898. .
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* This Field is required Information for: Username : Enter a memorable usename of at least 3 characters which may contain numbers as well as upper and lower case characters.<br />
* This Field is required Information for: Password : Please enter a secure password of at least 6 characters, no spaces. May contain upper and lower case, numbers, and /or special characters.<br />
* This Field is required Information for: Verify Password : Please enter a secure password of at least 6 characters, no spaces. May contain upper and lower case, numbers, and /or special characters.<br />
* This Field is required Information for: Name : Enter your name as it should appear on mail.  <br />
* This Field is required Information for: Email : Enter your valid email address - it will be used for all confirmations.<br />
* This Field is required Information for: Company : Enter company or business name.
Information for: Address : Enter company mailing street address.
Information for: City : Enter comany mailing city.
Information for: State : Enter company mailing state.
Information for: Zip Code : Enter company mailing zip-code.
Information for: Phone # : Enter your phone number (###)###-#### ext ####
Information for: Fax # : Enter your fax number (###)###-####
* This Field is required Information for: Services : Check mark all the services which you may wish to use. You may be contacted for additional information where needed to enhance provision of the service.
 
 
* This Field is required Information for: Non WC to Company Address? : Use company/contact address for items that are not W/C (e.g. physicals, drug screens, etc)? If no, provide the alternate address below.
Information for: other bill address : <p>Complete ONLY if non-WC items not billed to normal company address provided.</p>
    * This Field is required Information for: Bill WC through : <p>Should workers compensation items (medical care) be billed directly to the insurance carrier or to the company (to pay or forward)?</p> <p>Either way we need your carrier name in the next field . . .</p>
* This Field is required Information for: WC Carrier Name : Enter the name of your workers compensation insurance carrier.
Information for: WC Address : <p>Enter street address or box number for your work comp insurer billing.</p>
Information for: WC City : <p>Enter city for your work-comp insurer billing.</p>
Information for: WC State : <p>Enter state for your work-comp insurer billing.</p>
Information for: WC Zip Code : <p>Enter Zip Code for work-comp billing,</p>
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YOU MUST CLICK REGISTER BUTTON BELOW TO SUBMIT YOUR ENTRIES
note: for enhanced website security you will receive an email with a verification link to complete your account registration before login is allowed.
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