SMTP Access Request Form
Complete this form to request access to SMTP services. Please provide accurate information to ensure prompt processing.
Full Name
*
First Name
Last Name
Work Email Address
*
example@example.com
Department
*
Please Select
IT
Engineering
Marketing
Sales
Finance
HR
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Purpose of SMTP Access Request
*
Type of SMTP Access Needed
*
Send Only
Receive Only
Send and Receive
Application or System Name Requiring SMTP Access
*
Server IP Address (if applicable)
Duration of Access Needed
*
Please Select
Permanent
Temporary - 1 week
Temporary - 1 month
Temporary - Specify End Date
If temporary, specify end date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Manager/Supervisor Name
*
First Name
Last Name
Manager/Supervisor Email
*
example@example.com
Additional Notes or Special Instructions
Submit Request
Should be Empty: