Staffgenius User Registration

NEW CLIENT FORM- YOU ARE A GENIUS! FACILITY

Facility name

Facility Telephone

Facility Address

Facility Zip

Contact(Person filling out this form)

Contact Email

KEY CONTACTS
This is who we usually work with at facilities so why beat around the bush ? Tell us who you are now!

Schedule Name

Schedule Email

Administrator Name

Admin Email

Accounts Payable Contact

Accounts Payable Email

Contact For Contract

TEL

BILLING
Setting up an account at Staff Genius requires a card/ account on file. Don’t worry.We will never see your info. It’s in a secure cloud and we do not ever use it without a signed contract where we are all on the same page.

Payment Info

Your security is important to us. We do not store your credit card /account information. Online payments are passed via a secure socket layer to a payment processor where yourinformation is tokenized (whereby a random number is generated to represent your payment). The payment processor is PCI compliant which ensures that your information is being handled in accordance with industry security standards.!)