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Cloud User Request (Add and/or Disable Users)
Cloud User Request
I would like to:
*
Add a user
Disable a user
What type of user would you like to add? (Choose one only.)
*
Provider
Biller
Standard User
What type of user would you like to disable? (Choose one only.)
*
Provider
Biller
Standard User
What type of user would you like to add and disable? (Choose one only.)
*
Provider
Biller
Standard User
Office / Practice Name
*
Client ID / Account Number (can be found on Invoice):
*
Contact Name
*
First
Last
Contact Phone
*
Contact Email
*
Cloud Username - (If you are disabling a User):
Cloud Username - (If you are disabling a User):
Cloud Username - (If you are disabling a User):
Cloud Username - (If you are disabling a User):
Cloud Username 1 - (If you are disabling a User):
Cloud Username 1 - (If you are disabling a User):
Cloud Username 2 - (If you are disabling a User):
Cloud Username 2 - (If you are disabling a User):
Cloud Username 3 - (If you are disabling a User):
Cloud Username 3 - (If you are disabling a User):
Cloud Username 4 - (If you are disabling a User):
Cloud Username 4 - (If you are disabling a User):
Cloud Username 5 - (If you are disabling a User):
Cloud Username 5 - (If you are disabling a User):
Do you have additional users to disable?
*
Yes
No
Do you have additional users to disable?
*
Yes
No
Cloud Username 6 - (If you are disabling a User):
Cloud Username 7 - (If you are disabling a User):
Cloud Username 8 - (If you are disabling a User):
Cloud Username 9 - (If you are disabling a User):
Cloud Username 10 - (If you are disabling a User):
Do you have additional users to disable?
*
Yes
No
Cloud Username 11 - (If you are disabling a User):
Cloud Username 12 - (If you are disabling a User):
Cloud Username 13 - (If you are disabling a User):
Cloud Username 14 - (If you are disabling a User):
Cloud Username 15 - (If you are disabling a User):
Please proceed below: You must fill in both FIRST and LAST name if you are ADDING a new user.
Add User
*
First
Last
Add User
*
First
Last
Add User
*
First
Last
Add User
*
First
Last
Add User 1
*
First
Last
Add User 1
*
First
Last
Add User 2
First
Last
Add User 2
First
Last
Add User 3
First
Last
Add User 3
First
Last
Add User 4
First
Last
Add User 4
First
Last
Add User 5
First
Last
Add User 5
First
Last
Do you have additional users to add?
*
Yes
No
Do you have additional users to add?
*
Yes
No
Add User 6
First
Last
Add User 7
First
Last
Add User 8
First
Last
Add User 9
First
Last
Add User 10
First
Last
Do you have additional users to add?
*
Yes
No
Add User 11
First
Last
Add User 12
First
Last
Add User 13
First
Last
Add User 14
First
Last
Add User 15
First
Last
CLOSE
