/ I.T. SERVICE REQUEST FORM
A.S.–Division of Information Technology
Whatcom County Courthouse
311 Grand Ave, Suite 305
Bellingham, WA 98225
Phone: 360.778.5230
Fax: 360.778.5231 / ROUTING – I.T. USE ONLY
Network\E-Mail
VPN\Telephone
iSeries
Long Distance\World Card
CivicPlus / Permit Plan
Laserfiche
Phone Directory
Archive E-Mail
Remove Track-It\AD
Account ID ______Work Order # ______

INSTRUCTIONS

Complete and return this form to the A.S.-Division of Information Technology, Suite 305, Attn Service Desk. This form may also be emailed to . Changes may be started but will not be completed until a hardcopy with signature is received. This form can be found online at Service Request Form. This form should be completed by the IT Contact or supervisor. Please submit form at least 5 business days prior to desired completion date.

Please note the following information: Whatcom County purchases a limited number of costly E-Mail and Network account licenses. Please take this into consideration when requesting accounts for interns, volunteers and other individuals. Adding employees of outside agencies or consultants requires a written request from the Department Head specifying the reasons for the request. A.S.-Division of Information Technology may limit the user's access accordingly.

EMPLOYEE INFORMATION (Select one classification)

Name: / Department:
Employee#: / Office Location:
Job Title: / Supervisor:
Phone Extension: / Supervisor’s Extension:
Computer Asset Tag(s) Assigned: / Monitor Asset Tag(s) Assigned:

Regular Employee Temporary Employee Intern Volunteer Other (Specify)

ACTION (Select all that apply)

Create
Modify\Change
(Name, Job Title, Network Access) / Expire\Delete
Transfer files to:
/ Transfer Dept\Division
From:
To: / Account to Start on:
Date:
Account to Expire on:
Date:

ACCESS (Select all that apply)

Network
Copy username:

E-Mail
VPN
NOTE: Requires
completed Telework Agreement / New Telephone (hardware)
New Telephone Extension

Voice Mail
PIN Reset
NOTES: / iSeries (Standard)
Copy user name:

NOTE: Requires “Systems Access Form” found in APPOL to be sent to Finance.
Long Distance Code
World Card (remote calling) / CivicPlus
Permit Plan
Middle Initial:
Copy user name:

Laserfiche
Copy username:

OTHER / MODIFICATIONS / SPECIAL REQUESTS / SHARED FOLDERS / SHARED MAILBOXES

Preparer: / IT Contact / Supervisor

APPROVAL

I authorize the above individual to have access to the requested functions and have read and agree to comply with Whatcom County policy AD152001Z, "Using Computer Systems" and AD1520027 ″Managing Computer Systems.″
Dept. Head / Supervisor Signature: / Date

AD452001A V-20151229 12/29/2015