Username:    

Choose a username that is at least four (4) characters long; you may use numbers and/or letters.

First Name:    

Last Name:    

Phone Number:

Email:    

An email address is needed so that your password can be emailed to you if you ever forget it.

Password:

Confirm Password:

Affiliation with Tax ID:   Select Clearinghouse Billing Company TIN Employee TIN Owner Other

Tax Identification Number (TIN):  

Your 9-digit Tax Identification Number (TIN) should be entered without any spaces or dashes (-).

Draft Number VerificationI do not have a Draft Number

Draft Number:  

ECHO draft numbers contain no space or special characters and can be located on any past Explanation of payment.

Draft Amount:  

The Draft Amount should be entered without a dollar sign ($).