Please complete ALL of the details on this entry form before submitting. If you are unsure of any of the
details, please contact Customer Services to assist you.
Customer No. Your customer number.
Reference No. Any reference number provided to you or your organisation
to register your organisation for the Zellis Extranet or see
details of your organisation's Zellis Extranet Administrators.
This is used to verify your identity and must be correct.
First Name: The details for the first user account you will create.
Last Name:
E-mail: An e-mail address is required for online users.
Verify E-mail: Repeat your e-mail address to ensure it was entered
Password: Choose a word or number combination that is not easy to
guess and that you will remember.
Verify Password: Repeat your password to ensure it was entered correctly.

This Extranet and the information contained herein is the exclusive property of Zellis and is strictly confidential. It has been provided for authorised use by Zellis customers and employees only. Unauthorised use is strictly forbidden. Anyone using this site is responsible for maintaining the confidentiality of passwords and site information. See our full Privacy Policy