Deactivate User Request Form

This form is used when you are needing to remove the access of a current user of CertiPay.

***If you need to add a New User- the New User Request Form can be located here: New User Setup Request. ***

Company Information: 

The top of the form must be filled out in its entirety. Please ensure that the “Requested By:” is the Decision Maker of the company. A Decision Maker is the individual that can request company level changes. The Decision Maker must submit the document to us or be CC’d on the existing request and email approval.

User To Be Deactivated: 

User Name – The user’s first and last name 

User Email – Email of the registered user 

Deactivate User for The Following Control Number(s) – List each control number associated with your account with us that the user’s access should be removed from. This will ensure that the proper security is removed from each one. 

Deactivate User Access: 

In the next section, please list all that apply to the user. If the access of the user is unknown, please reach out to us via ClientServices@CertiPay.com for clarification.   

The replacement user needs to be listed to keep potential delays from happening in the future. 

Notes:

Any additional notes can be placed at the bottom of the form. 

Once completed, please save as a PDF file and email in to ClientServices@CertiPay.com.