Cloud Clients – Add and/or Disable a User

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 1 - (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 4 - (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

Cloud Clients – Add and/or Disable a User

Cloud User Request

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