Register - Benefit Briefcase

Create your new Benefit Briefcase account

All fields are required

UserName: Minimum 6 characters, maximum 12 characters

No special character

Password: Minimum 6 characters, maximum 12 characters

At least one uppercase. one lowercase, one numeric and only one special character

Special characters allowed: (!$?_)

Social Security: No-dashes

First Name The First Name field is required.

Last Name The Last Name field is required.

PhoneNumber

UserName The UserName field is required.

Password The Password field is required.

ConfirmPassword The ConfirmPassword field is required.

PinCode The PinCode field is required.

Social The Social field is required.

Email The Email field is required.

ConfirmEmail