Use this form to add, modify or delete access to CCMS (CitiDirect® Management System) or CCRS (Citibank® Custom Reporting). See the final page of this document for a more comprehensive set of instructions for completing this form. Questions? Contact Commercial Card Services Norfolk toll-free 1-866-670-6462 from the U.S. and Canada or, if dialing from international locations, call collect 757-853-2467. / Date:
Attention:
Fax: / 866-951-8005
757-818-6893
Select one or both: / EAS Access Point of Contact
Section I: System Access Request Parameters
Action Required: / Add (Primary) / Modify / If requesting “Modify” or “Delete”, provide User ID in space below
Add (Alternate PC) / Delete
Systems Included: / CCMS: CitiDirect® Card Management System î î î / Select Level Access: View Only Maintenance
CCRS: Citibank® Custom Reporting System î î î / Select Level Access: Schedule & View Write, Schedule & View
(HL 4, 5, 6, 7) (HL 1, 2, 3)
Section II: User Information*
Name:
Last / First / MI
Agency / Organization:
Contact Information:
Street / Apt.#
City / State / Zip
Country
Business Phone / Ext. / Fax Number
Email Address / Verification Information
Section III: Hierarchy / Reporting Parameters
Important: List Agency / Organization name and the five (5) digit hierarchy / reporting code for each hierarchy level to which access is required.
Hierarchy Unit Name / HL1 / HL2 / HL3 / HL4 / HL5 / HL6 / HL7
Section IV: Authorization
APC:
print or type / Business Phone / Ext.
Signature / Date
Instructions Sheet
Purpose: / Use this form to add access, change or delete access to the CCMS (CitiDirect® Management System) or CCRS (Citibank® Custom Reporting) via the Citibank® Electronic Access System (EAS).
Instructions: / Who: / Authorized Officials should complete this form
When: / Complete this form when there is a need to add, modify or delete system access for a user
How: / Select One: / Identify whether this form is to request EAS Access or to identify a point of contact
Section I: / Action Required: Select action to be taken on user’s access. If modify or delete is selected, provide the User ID in the space provided
Systems Included: Select appropriate systems and level access
Section II: / Name: Enter user’s full name - Last, First, Middle (maximum 24 characters)
Agency / Organization: Enter the complete name of the agency / organization of account holder
Contact Information: Enter contact information for account holder including complete physical mailing address, business and fax phone numbers (including area code) and verification number. The verification number is to be provided by the account holder and will serve as an identification password (i.e., a control number). It is recommended to use the last four digits of your SSN. This will be requested when the account holder contacts Citibank® Customer Service for assistance.
Section III: / Hierarchy Unit Name: Enter the name of the hierarchy unit.
HL1 – HL7: Enter the 5-digit hierarchy level number(s) for which the user will have responsibility.
Section IV: / Authorization:
· APC Name: Type/print name of person authorized to approve the request. The approver should be an APC at the same level or higher.
· APC Signature: APC must sign.
· Business Phone Numbers: The business phone number must be a commercial access number and must include area or country code.
· Date: Type/print date signed by APC.
Submit Request form with supporting documentation via mail or fax as follows:
Citibank Commercial Cards
P.O. Box 10085
Norfolk VA 23513 / FAX TO: 866-951-8005
757-818-6893
Global Transaction Services
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