StarStone Online Services Registration Form
Report Payroll, Make Payments and View Statements
Policyholder Information
(as shown on policy)
* Policy Number :
* Insured Name :
* Federal Employers Identification Number :
Individual authorized to administer access to the StarStone Online Services
* Email Address :
(Your Email Address is your User ID)
* First Name :
* Last Name :
* Phone :
Ext :
†
Select this box to confirm that information provided above is correct.
† By clicking the box I agree, in the absence of my written signature, this is the electronic representation of my signature and confirmation that information provided above are correct. I further understand that this electronic signature will have the same legally-binding effect as signing my signature using pen and paper.
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