New User Set Up Request Form

This form is used when you are needing to add a new user to CertiPay. 

***If you need to Deactivate a User- the deactivate user Request Form can be located here: Deactivate User Request ***

Company Information: 

The top of the form will have to 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 is setup with CertiPay to be able to request company level changes. The Decision Maker must submit the document or be CC’d on the request and email in approval. 

New User Information: 

User Name – The user’s first and last name 

User Email – Email of the registered user 

Phone Number – The best number to reach the user 

User Title – The title of the user within your company 

Required Information – Please check the boxes that best fits the user’s role. If not listed, check “other” and list the role in the blank field 

Please indicate if the new user will replace an existing user. If so, you will also have to fill out a Deactivate User Request Form which can be located here: Deactivate User Request

Accessibility: 

In the next section, please list all that apply to the user.   

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.