Worldline Global

Requestor

Your first name*

Your last name*

Your email address*

Your company [automated field]

Your request

ACS screens	Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt
Premium GUI - CM	Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt
Supervision screens	Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt
IP4C	Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt
Digipass	Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt

Number of requested digipasses*

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VAT number*

Reference number (P.O.) - optional

Sent the digipasses and the init-pins to the same address?*

Yes No

Delivery address digipass*

Delivery address documents and init-pins

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User 1 - First name*

User 1 - Last name*

User 1 - Email address*

User 1 - Digipass number*

User 1 - Access to supervision on Monday*

Yes No

User 1 - Access to supervision on Tuesday*

Yes No

User 1 - Access to supervision on Wednesday*

Yes No

User 1 - Access to supervision on Thursday*

Yes No

User 1 - Access to supervision on Friday*

Yes No

User 1 - Access to supervision on Saturday*

Yes No

User 1 - Access to supervision on Sunday*

Yes No

Please download our template here.

After completion the document must be uploaded via the Upload button.

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Email linked to userID*

UserID in the environment*

Does the user knows his password?*

Yes No

Optional - Describe the issue

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Changes for one user per request. For modifications of multiple users at once (ex: email domain, bank name ...) you can use our Excel template. Does it concern multiple changes?*

No Yes

Email address user linked to the WL userID*

WL UserID*

Change the PROFILE - ACS?*

Yes No

Change the PROFILE - GUI CM?*

Yes No

Change the PROFILE - GUI IDM?*

Yes No

Change the ENVIRONMENT?*

Yes No

Change the DIGIPASS?*

Yes No

NEW digipass number*

Change the EMAIL ADDRESS?*

Yes No

ACTUAL email address*

NEW email address*

Validation

Charges can apply for the order of digipasses. Do you agree with the additional charges?*

I agree

Charges can apply for the creation of new users. Do you agree with the additional charges?*

I agree

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