UCMC AFFILIATES E-MAIL AND REMOTE ACCESS SIGN UP FORM

UCMC AFFILIATES E-MAIL AND REMOTE ACCESS SIGN UP FORM

In order to maintain an efficient and low cost billing system you are requested to include payment with your e-mail service request. When paying for corporate employee accounts, payment should be made by corporate check, made payable to the University of Cincinnati or by the University form A-169 (NIU-Bill for Services or Expense Transfer). Form A-169 (NIU) can only be accepted as payment if the fund being charges is a PPR fund (fund account number beginning with an “O” and ending with a “Z”).

Note1: Please note that each application will be validated and the account(s) may be audited periodically.
Microsoft Outlook/Exchange Email $120.00 annual
New Account     Renewal  
($180 total for new account)		 $60.00 one time
Note2: For VPN and Remote Access Request, please refer to UCit’s GETit online application: https://ucit.uc.edu/GETit/default.asp

All charges will be prorated based on the fiscal year.
If payment is not made, the account will expire.

Date:
(mm/dd/yyyy)
First Name: Last Name:
Middle Name: Department/Organization:
Position: Work Phone:
(xxx-xxx-xxxx)
Birth Date:
(mm/dd/yyyy)		 UCID:
Current email account, if any:
NIU# Account Number:
A NIU# number OR a check is RequiredPlease send NIU or make checks payable to:
University of Cincinnati, AIT&L
231 Albert Sabin Way ML 0574
Cincinnati, Ohio 45267-0574
Check Number:
Email account to notify when account is done: