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PS 5118

County Project Web Access Request Form (2/2011)

Download and Print the PS 5118

Request may not be processed if the form is incomplete or illegible.

This form will be used to create a Web-based account with the National Customer Support Center (NCSC) which will be utilized to send/receive (upload/download) files for County Project to/from the RIBBS® website.

Please complete this form and return via United States Postal Service® mail to the address at the bottom of this form.

A representative will contact you by phone with details regarding
your approved access.

A. Customer Information

1. Name

2. Job Title

3. Telephone Number (include area code)

4a. County Name

5. Email Address

6. Business Address

7. Corporate HQ Location (if different from your Business Address)

B. Customer Computer Access Authorization

User Responsibility Agreement Statement: I am responsible for Logon/Logoff, all actions pertaining to the use of my assigned logon ID, and will not provide my logon ID to another person.

I agree that access to computer data or fi les not authorized to me is prohibited.

I understand my logon ID may be suspended indefi nitely if I violate security procedures or fail to provide update information for the information listed above whenever I change job positions.

I agree that misuse of a USPS® computer system may result in disciplinary action and/or criminal prosecution. I understand that any detected misuse of a computer system will be reported to the
Inspection Service.

And much more...