Ease Placement | Facility Register

Facility Information

This function assists you in adding facility information to our system if it doesn't already exist in the search results. To confirm the non-existence of your facility, please initiate a final validation check by clicking "Run Facility Validation".

Facility Name *

Facility Type *

License Number *

Street address *

State *

City *

County *

Zipcode *

Licensee Name *

License First Date *

Administrator Name *

Contact Number *

In order to register in our system, we require your personal information to create access to your dashboard.
Please kindly provide all the necessary information in the fields below.

First Name *

Last Name *

Email Address *

Phone No. *

Username *

Password *

Re-type Password *

I hereby agree to the Terms of Service and have read or acknowledge our Privacy Statement.

I agree to the terms of the E-Sign Act Disclosure Agreement. I acknowledge that by checking this box, I consent to the use of electronic records and signatures in place of physical documents, and that I have read and agree to the terms outlined in the E-Sign Act Disclosure Agreement.

I agree to the terms of the Uniform Electronic Transactions Act (UETA) Agreement. By checking this box, I consent to the use of electronic records and signatures in place of physical documents, and I acknowledge that I have read, understand, and agree to the terms outlined in the UETA Agreement.

Facility Information

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