Email Registration Tool

Register for Online Ordering

StaplesAdvantage.com is Staples' internet ordering solution. Please complete the UMass Memorial Healthcare custom online registration form below to have your profile created. You will be asked for your cost center VP which is located on Ournet/Administrative/Finance/Lists/Financials Cost Center Listing.

PLEASE NOTE COST CENTER FORMAT EXAMPLE: cost center 999.0.40.5910.8409.00 would be entered as 999-0405910-840900

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Fields marked with an * are required.

* Primary Hospital Name/Entity:

* First Name:

* Last Name:

* Primary Address (NO POX Boxes):

* Department Name:

* Floor/Suite #:

* City:

* State:

* Zip Code:

* Phone:

- - X

* Email:

* Primary Cost Center:
Ex. ###-#######-###### (999-0405910-840900)

* Cost Center Vice President:

* Cost Center Vice President Phone:

- - X

* Cost Center Vice President Email:

Hospital Name/Entity:
Enter Address, City, State, Zip

Enter Additional Hospital Name/Entity

No. of additional Hospital Name/Entity:

Department:

Enter Additional Department

No. of additional Department:

Address:
Enter Address, City, State, Zip, Room/Floor Number

Enter Additional Address

No. of additional Address:

Cost Center:
Ex. ###-#######-###### (999-0405910-840900)

Enter Additional Cost Center

No. of additional Cost Center:

Cost Center Vice President:
Enter First & Lastname, Phone, Email Address

Enter Additional Cost Center Vice President

No. of additional Cost Center Vice President: