ADMINISTRATIVE SYSTEMS, INC.

ASI now has on-line billing available. On-line billing allows you to do the following on a secured
basis:

   1. Pay bills electronically.

   2. Change employer account information.

   3. View your billing statement, print it, and pay via check.

All you need to get started is a login ID and password. If you don’t already have a login ID and password, you can complete the bottom portion of this form and mail it to:

   Administrative Systems, Inc.
   Attn: Billing Department
   1310 Mercer Street, Suite 200
   Seattle, WA 98109

If you already have the login ID and password, just open the ASI website at www.asibpi.com. Then do the following:

   1. Click on Employer Center (or For Employers)

   2. Click on Employer Info (or E-Bill)

   3. Enter your Employer Number (your login ID) and Password

   4. Choose either Pay Your Group Bill Online or Edit Company Information

Note: You will continue receiving paper billings unless you specifically request ASI not to mail you a bill.

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REQUEST FOR LOGIN ID AND PASSWORD

        Employer Name__________________________________________

        Employer ID____________________ Your name________________

        Your e-mail address:_______________________________________
                                    (The ASI login ID and password will be emailed to this address)