Third-Party Access Request Form

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					Third-Party Access Request Form
The purpose of this form is for a third party to apply for information systems and/or server room access.
Please fill out all appropriate sections and return to the IT Manager for approval.

Server Room Access
I, ___________________________ (print name), hereby request access to the following server room at
<Your Company Name Here>.

Applicants Name:

Applicants Address:

Phone/Fax/E-mail:



Server Room Location: _________________________________________________________________

Purpose of Access: _____________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Duration of Access:

         Start Date: __________________________ End Date: __________________________________

Hours of Access Requested:

         Start Time: __________________________ End Time: __________________________________

Temporary ID Requested (circle one):                  Yes               No

Supervisor’s Name: ____________________________________________________________________

Additional Comments: __________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________




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