Select the type of request.

Enter the user's first name.

Enter the user's last name.

Provide a work phone number in the format 123-456-7890.

Provide a cell phone number in the format 123-456-7890.

Enter an email address for the user where communication can be sent and received.

Select the group the user belongs to.

Select the group the Company belongs to.

Select the Agent Company the user belongs to.

Select the Wire Center the user belongs to.

Select the Department the user belongs to.

Select the Job Title the user belongs to.

Create a unique Login ID. It can be the same as the Login ID for the company server.

Create a password that is at least eight alpha and/or numeric characters in length. Please do not include symbols.

Re-enter the password to confirm.