New User Creation Request

Employee Start Date: *

Requestor Name *

First

Last

Requestor Email *

Requestor Phone:

New User Full Name: *

First

Last

Requested username: *

Requested Email: *

Employee Location: *

Existing User to Copy: *

Office License Required: *

Allow access to the following drives:

Add user to these email distribution groups:

Access to these specific applications:

Additional Notes/Requests:

If your company uses Star2Star phones, please fill out the remaining information. If not, please submit the request.

Office Extension Number:

Desktop (Softphone) Extension Number:

Desktop Operating System:

Mobile Extension Number:

Mobile Type:

+1 (845) 876-6561