Request for Telecommunications Backup

Account Number (this is the last 6 digits of a Telecommunications Invoice): 

Office Address:

Street:______________________________________________________

City:_______________________ State:________ Zip:________________

PAS#:

This form is set up so that you can quickly request access for multiple people in your organization.  If you do not know the VPRT Printer ID, you will need to speak with your IT technician to get it.  The Printer ID might be the same for everyone, but it might be different. You do not need to complete the VPRT Printer unless you mark Mainframe as your access type.

You can complete the form for multiple people in your agency at once.

You can download the form below. Please return the Word or Google Doc document to tcr@wv.gov, not a PDF copy as staff needs to add the account numbers to the bottom of the form to process.