Contact Change - User Login Request Form

Contact Change - User Login Request Form

Please complete the form below to add/remove/change a contact on your Asure account.
Company Number*
Company Name *
Contact Name*
Contact Title*
Contact Email Address*
example@example.com
Contact Phone Number*
Payroll Specialist*
I would like to:*

Add / Change / Remove Contact
Are you adding a new contact, removing a contact, or making a change to an existing contact?*
Please enter the current and updated information for the user below.
This contact will be
Please note: The Primary Contact will be the first point of contact, and the one who receives newsletters and email updates from Asure.
Name of Contact
Title
Phone Number
Extension
Cell/Alternate Phone Number (optional)
Fax Number
Email Address
example@example.com
Authorization Levels - Please choose one for each option
Employee Information
Company Information
Assign software user rights?*
Add email for electronic report delivery (VMR)?*
Email address for electronic report delivery
example@example.com
Additional Notes
Name of contact you are removing
Date you would like this contact's access removed on

MonthDayYear
Date
Inactivate system logins (select all that apply)

Payroll - HRTimekeepingElectronic Report Delivery (VMR)
Please sign below to confirm changes

Remote User Access

Asure will review the application platform(s) assigned to your account and provide access where appropriate.
User Full Name:
User Phone Number:
User Email Address:
Log In ID: PROVIDED BY ASURE

Password: You will be assigned a temporary password by Asure which will need to be changed within 5 days.

Passwords must be a minimum of 8 characters in length. They must include 2 of the 4 following combination elements:
- Capital Uppercase Letter - ABCD
- Alpha lowercase - abcd
- Numeric - 1234
- Special character - !@#%^&*()_+{}[]| (the $ is not considered a special character.)
Please select the access you would like this user to have below.
Payroll - HR
*** Please define the restricted access you wish to provide. Asure will review and follow up to confirm & test.
Timekeeping Access (Admin users only)
Click here to request a training for a new remote user.
Please sign below to confirm changes

Third Party Remote User Access
I would like to:
To the following third party company:
Relationship to client:
3rd party contact name:
3rd party contact phone number:
3rd party contact email address:
example@example.com
If your company is enrolled in our VMR (Virtual Mail Room) service, please check this box if you would like the above email address to receive e-mail copies of payroll reports/quarterly returns.

Yes, please allow above email address to receive copies of payroll reports & quarterly returns.
Please be advised: The company understands that these rights are grandted and/or removed based on the effective data of this notification to Asure.

Asure reserves the right to approve or deny these access requests based on our terms of service.
Approved by:
Effective date:

MonthDayYear
Date
Please sign below to confirm changes

Add / Change / Remove Contact