Field |
Definition |
First Name |
This is the name of the person who needs access. There must be a first and last name associated to each profile. |
Last Name |
This is the name of the person who needs access. There must be a first and last name associated to each profile. |
Organization |
This agency name or department of the person who needs access. |
Telephone |
This is the 10-digit number to reach the submitter, with or without dashes. You can add an extension, if appropriate. For example: 916-555-1212x6789 |
Question1 |
This is the first security question you will be asked if you ever forget your password. |
Answer1 |
This is the answer to your first selected security question. |
Question2 |
This is the second security question you will be asked if you ever forget your password. |
Answer2 |
This is the answer to your second selected security question. |
LoginID |
This is what you will use to log in to the system. It is your choice between 6 and 10 characters. |
User Type |
Choose agency administrator, agency user or bill payer user, as defined above. |
Billing Account Number |
Though you may need access to more than one Billing Account Number (BAN), you can only list one here. An agency administrator or agency user, will automatically get access to all of the accounts for the given agency. Bill payer users can list additional accounts in the Notes section or attach a list. |
Invoice Number |
Though you may need access to multiple accounts, you can only list one invoice number here. The system associates the invoice number to Billing Account Number (BAN) and Customer ID to provide you with the correct access. An agency administrator or agency user, will automatically get access to all of the accounts for the given agency. Bill payer users can list additional invoice numbers and/or BANs in the Notes section or attach a list. This field is not required if a Billing Account Number was provided. |
Work Address Line 1 |
This can be the work address where the bills are sent or where the employee is physically located. |
Work Address Line 2 |
An optional field, if you need to populate the room or floor number of your work address. |
Work City |
This can be the work city where the bills are sent or where the employee is physically located. |
Work State |
This can be the work state where the bills are sent or where the employee is physically located. |
Work Zip |
This can be the work zip code where the bills are sent or where the employee is physically located. |
Does your Agency participate in the E-Rate program? |
If you hover your mouse over this question, it will provide details about the E-Rate program so you can choose the appropriate response. |
Notes |
Though this isn't a required field, this is where you should list additional BANs that you will need to access. |
Upload File |
Once you submit the form, you will be given the option of adding an attachment. This could be a Letter of Authorization (LoA) form for contractors or a list of accounts that the user will need to access. |