Keeping You and Your Data Connected

New User - Network Access Request

Please complete the form below and submit. The Gennix helpdesk will create a service ticket to create the new account and respond to the person who initiated the request.

New User Request Form

Requestor's Information

Requestor's Company Name

Requestor of New User Account

First Name

Last Name

What is the requestor's email address

New User Information

New User Name

First Name

Last Name

Location

New User - Telephone Number

(###)

###

####

Job Function

Start Date

YYYY

Manager

First Name

Last Name

Unique Windows account required?

Yes

For access to network resources, whose access should this new account be mirrored on?

First Name

Last Name

Does this new user require an email address?

Yes

If so, please provide email address for the new user

Does this user need to be a member of any email distribution lists?

Who needs to receive the new user account and/or email account password

First Name

Last Name

Workstation required

None

Re-use an existing workstation

Require a quote for a new workstation

Software/Application requirements

What specific software does this new user require?

Additional information

New User - Test

New User - Network Access Request

Are you already one of our Clients?