KEY BENEFIT ADMINISTRATORS
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Password:
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Provider Registration
Required fields are marked with ** in red.
Provider Name:
**
[?]
You must enter your name.
EIN\TIN:
**
[?]
You must enter a EIN\TIN.
Zip:
**
(5 numbers, no punctuation)
You must enter a Zip Code.
Phone #:
[?]
Fax #:
[?]
UserID:
**
Same as EIN\TIN
[?]
You must enter a UserID.
Password:
**
[?]
You must Enter a password.
Password must be 8 characters and have both letters and numbers.
Re-enter Password:
**
You must Re-Enter a password.
Your password and re-entered password do not match.
Email Address:
**
[?]
You must Enter an Email.
Please enter a valid email.
Your email and re-entered email do not match.
Re-enter Email:
**
You must Enter an Email.