Clear Form

Non-Employee IT Access Form
User Information: (All fields required)
Start Date:

First Name:

Last Name:

Preferred Name:

Employer:

Manager:

Title/Position:

End Date: (if consultant, temp or other short-term)
Access Configuration

Default Domain: @Bertelsmann.com

@bdmifund.com (for BDMI use only)

Mirror Account Access:
Software

Hardware

SAP

Computer Need?

Y

N

MS Teams

Deskphone/VM?

Y

N

Adobe Pro

Cell Phone Plan?

Y

N

Zoom
Efax
VPN
Box.com
GotoMyPC

Requester Signatures
Requesting Manager Signature:

Network Drives List: