External GOA User ID Create Form by Yearoveryear


									                                External GOA User ID Create Form
The following information is required for each external client that will require a GoA account to access specific
extranet services available through SecureXNET.

 First Name:                                               Initial:                  Last Name:
 Title:                                                    Phone:                  (  )                     Fax:         (     )
 Company:                                                  Branch:
 Floor:                                                    Building:
 Address:                                                  City:
 Province:                                                 Postal Code:
 Supervisor Name:                                                  Phone
                                                                   (    )
 Start Date:                                                       Expiry Date:

 Provide User Specific Client Email Address (for GOA or EXTERN ID only requests):

 Additional Information: (SecureXNET service required)

 Company Client ID (LSAS)

The personal information collected on this form is collected in accordance with S. 33(c) of the Freedom of Information and Protection of Privacy
(FOIP) Act, RSA 2000, Chapter F-25. Your personal information is used to create a user-ID for your use while accessing GOA extranet services
through SecureXNET, or other reasonably related administrative purposes. Your personal information will not be used for other purposes without
your consent unless required or authorized by law. If you have any questions about the collection, use or disclosure of your personal information
please contact Mike Michaud, Section Head, 2nd floor, 9915 - 108 Street, Edmonton, Alberta T5K 2G8, Phone (780) 422-0020.


    For EDS or PCS account requests
     Fill in the above form and email to eds.support@gov.ab.ca
     EDS Support will contact the above person at the phone number indicated to verify the email address
       and information before requesting a GOA account. An EDS account will be provided to the client at
       that time.

                  It is important that the Client’s middle initial be entered, as it may be required in the case of
                   duplicate names.
                  The account should be created within ten business days.
                  Once account is created, the applicant will be notified.

GOA User ID Create Form.doc                                              1                                                      Dec 18, 2006

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