Employee Badge Pickup Form
Please complete this form to request and collect your workplace badge. All information is required for badge distribution.
Full Name
*
First Name
Last Name
Employee ID (Internal)
*
Department
*
Please Select
Human Resources
Finance
IT
Operations
Sales
Marketing
Other
Work Email Address
*
example@example.com
Badge Type
*
Please Select
Standard Access
Restricted Access
Visitor
Contractor
Temporary
Pickup Location
*
Please Select
Main Reception
Security Desk
HR Office
Other
Preferred Pickup Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Pickup Time
*
Hour Minutes
AM
PM
AM/PM Option
Pickup Method
*
In Person
Proxy (authorized person)
Submit
Should be Empty: