Create Facility Account Vendor Credentials

Complete the information, including choosing a login and password. (You will be prompted for any incorrect or missing information.) Agree to the terms and conditions and choose Continue . In order to create a facility account, a security code issued by Vendor Credentials is required. For security reasons, this will be issued directly to the facility by a Vendor Credentials representative.

Login Information
Security Code: In order to create a facility account, a security code issued by Vendor Credentials is required.
Login: Unique login that allows access to account information.
Password: Password must be 5-20 unique alphanumeric characters.
Re-Enter:  
Medical Group: The medical group to which the facility belongs, if applicable.
Contact Information
First Name: The first name of the person who is the contact for facility.
Last Name: The last name of the person who is the contact for facility.
Email: A valid email contact address for the contact person. This will be the primary means of communication, so please keep it current and provide an address that is regularly monitored.
Phone: The preferred contact phone number for the person listed as the primary contact.
Best Contact Time:
The general time of day that is most convenient for you should Vendor Credentials need to contact you by phone or visit.
Facility Information
Name: The name of the specific facility represented by this account.
DR Login Information
Login: Unique doctor login that allows access to doctor appointments.
Password: Password must be 5-20 unique alphanumeric characters.
Re-Enter:  
Address: The preferred mailing address for contact purposes.
City: State:
Zip:
Type: A general description of the facility's purpose.
Upload Facility Logo: To up load a new logo file, use the Browse feature and select your file. It will be saved to your account. Please note that the image saved here will be displayed on vendor badges. Accepted formats are .jpg, .bmp, and .gif.  
Website for Facility: The website for the facility. Please enter the website address most specific to your location.  Please use the www.domain.com format. No 'http:' prefix is required.  
Legal Agreement
On behalf of Facility, I agree to be bound by the terms of the Agreement set forth.