Client Access Customization Form

Company *

Account Administrator *

First

Last

Email *

Phone *

Access (Select one) *

Add
Remove

Name *

First

Last

Client ID *

Email *

Phone *

Select All That Apply *

Enter Reports
View Reports
View Invoices
Billing Contact

Each contact will receive a username and password via email. SMS text messages will be sent to cellular numbers for a personal identification number only. This form may be reproduced for additional users. Billing Note: Monthly invoices are sent via email to billing contact(s) only. Please complete the Billing Information / Automatic Payment Authorization Form for all other billing changes.

Add or Remove Another User *

Yes
No

Access (Select one) *

Add
Remove

Name *

First

Last

Client ID *

Email *

Phone *

Select All That Apply *

Enter Reports
View Reports
View Invoices
Billing Contact

Each contact will receive a username and password via email. SMS text messages will be sent to cellular numbers for a personal identification number only. This form may be reproduced for additional users. Billing Note: Monthly invoices are sent via email to billing contact(s) only. Please complete the Billing Information / Automatic Payment Authorization Form for all other billing changes.

Add or Remove Another User *

Yes
No

Access (Select one) *

Add
Remove

Name *

First

Last

Client ID *

Email *

Phone *

Each contact will receive a username and password via email. SMS text messages will be sent to cellular numbers for a personal identification number only. This form may be reproduced for additional users. Billing Note: Monthly invoices are sent via email to billing contact(s) only. Please complete the Billing Information / Automatic Payment Authorization Form for all other billing changes.

I certify I am a duty authorized representative of this organization. I have authority to request the changes above.

Account Administrator Signature *

Name *

Date *

Client Access Customization Form

This form allows account administrators* (only) to customize the levels of access your users will have:

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