SERPIC Request Form

SERPIC is the parts identification program maintained by DEUTZ Corporation AG. Every distributor and dealer location will need access to SERPIC to perform work duties on a daily basis. This access is distributed through a single sign-on platform. Deutz is currently only authorizing (2) license per location. Please provide the name of the person that will be recieving this access.

Purpose of SERPIC Request*

Request Included Licenses (2 per dealer location)Request Additional Licenses (Cost associated)

Date*

Date

DEUTZ Business Type

Distributor/CC3 DealerCC2 Dealer

Any user assigned a level 3 or higher SERDIA interface has access to SERPIC through that interface. Please do not submit for additional access as it will not be processed.

Purpose of SERPIC Request*

Request included licenses (2 per dealer location)Move existing license to new user.Request additional licenses above allowed count (Cost associated)

Is the former user still with the company?*

YesNo

If this selection puts your organization over the (2) licenses allowed, is your organization willing to incur the additional $400 license fee per license over?*

YesNo

Bill to Distributor/Direct Dealer

Bill to GPA

PO for additional licenses

GPA Number*

Business Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Manager Submitting Request*

First NameLast Name

Manager's Email*

example@example.com

Applicant to remove access to SERPIC

Employee losing license

First NameLast Name

Email of employee losing license

example@example.com

Applicant requesting access to SERPIC

Currently if someone in your organization already has this access, this request could result in them losing that access. Only two licenses are currently allowed per location.

*Additional accounts will result in additional fees once allowed*

Applicant #1 Name*

First NameLast Name

Applicant #1 Email*

example@example.com

Applicant #2 Name

First NameLast Name

Applicant #2 Email

example@example.com

Requester's Signature Authorizing PO