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Create an Account
Hidden
Is User Logged In?
Hidden
Register or Create
Dynamic Variable passed to this field by menu item. If the form is filled out on the frontend by a potential account holder, then the variable will be "register." However if the form is filled out on the dashboard by SHI staff, then the variable will be "create."
Account Name
Account Name Validation
This field is dynamically populated with the account name above, to warn the user, that an "account with that name, already exists."
Business Address
Street Address
City
Business State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contacts
Please note, that the main contact will the the master account user for this account, and when this account is created, he/she will receive credentials to login to the account.
Main Contact
(Required)
First
Last
Email
(Required)
Phone
Position
Additional Contacts
Additional Contacts
Role
Email
Phone Number
Add
Remove
Hidden
Notifications
Hidden
From Name
Hidden
From Email
Hidden
Reply To Email
Hidden
BCC Email
Hidden
Subject
Hidden
Email Body
Welcome {Account Name:1}
Hidden
Admin Email
Hidden
JW Notifications (New Accounts)
Hidden
JW Notifications (New Accounts) CC1
Hidden
JW Notifications (New Accounts) CC2
Hidden
JW Notifications (New Accounts) CC3
Hidden
SHI Notifications (New Accounts)
Hidden
SHI Notifications (New Accounts) CC1
Hidden
SHI Notifications (New Accounts) CC2
Hidden
SHI Notifications (New Accounts) CC3
Hidden
"Main Account Holder" Role Default Value
Default value field "Main-Account-Holder" used for the user registration feed of this form, used to assign the role "Main-Account-Holder" to the user meta key, "account_role."
Hidden
"Master" Default Value
Default value, "Master" used to Assign "Master" to the user meta, in the user registration feed of this form.
Hidden
Test Account?
Yes
No
CAPTCHA
Username or Email Address
Password
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URL
Link Text
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