Common use of Request Type Clause in Contracts

Request Type. Add access for new employee/third-party vendor Delete access for existing employee/third-party vendor Change access for existing employee/third-party vendor Name change for existing employee/third-party vendor Former name: I have read the provisions set forth on Page 2 of this form. I understand that Wisconsin Statutes, § 943.70 provide criminal penalties for offenses against computer data and programs. Violation of this provision will result in termination of my online access to member accounts and/or termination of my employer’s online access to member accounts. Employee name (first, middle, last) Vendor name (if applicable) Work address IAM login ID Check here if you do not currently have an IAM login Work email address Employee or vendor signature Work telephone ( ) Date (MM/DD/CCYY)