Service Request: Departing Team Member

If you are human, leave this field blank.

Organization *

Requester Name *

Requester Email Address *

Requester Phone Number

First Name *

Last Name *

Email Address

Phone Number

Team Member Departure Date *

Please estimate if unknown.

Team Member Location

Required if organization has multiple locations.

Department/Team

Manager/Reports To

Hardware *

We need to re-image a computer.

We need to move team member's files to an archive.

We need to destroy a computer hard drive.

We need to recycle an old computer.

Please check all that apply.

Software: Are there any software licenses we need to reclaim from this team member's computer?

Access/Restrictions: Please list any systems we must remove this team member's access to.

Organization and department defaults are used if this field is left empty.

Other Comments/Requests

Attach any necessary documentation here.

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