Long Distance Authcode Requests

1. Requestor Name:
2. Requestor Email Address:

3. Are you completing this form for yourself, or on behalf of someone else?

   Self On behalf of someone else

4. Employee (Full Name):
5. Employee ID:

All requests must be approved by an authorized manager or supervisor. A separate authorization code should be requested for each person needing long distance access.

1. Request a new authorization code

1. SpeedType:
2. Approved by:

1. Deactivate an authorization code
2. Code to Deactivate:
3. Username:
4. I forgot my authorization code