Employer Registration

Username must be:

6 to 20 characters
can contain alpha, numeric, or - _ . characters
not contain Employer ID

Password must be:

8 to 20 characters
contain a combination of alpha numeric, and special character
Allowed Special Characters are:
At Sign- @, Pound- #, Dollar- $, Dash- -, AND- &, Underscore- _
at least one upper and one lower case alphabetic character
Example: Welcome@1

The Employer ID should be the nine digit Federal Employer Identification Number assigned by the IRS (with no dashes). If you do not have a Federal Employer Identification Number, please complete IRS Form SS-4 found at http://www.irs.gov/uac/Form-SS-4,-Application-for-Employer-Identification-Number-(EIN).

Create Username and Password

Username * Username cannot match Employer ID (FEIN)

Password *

Confirm Password *

Employer Details

Employer ID (FEIN) *

Confirm Employer ID *

Employer Name *

Phone *

Employer Address

Is Foreign Address

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Primary Contact

Name *

Phone *

Email *

Confirm Email *

Secondary Contact

A secondary contact is highly recomended for future situations where the primary contact is no longer with the employer and a password reset is required.

Name

Phone

Confirm Email