Please complete form in all CAPS.

Requestor Information

Name

Type

Phone Number

Access Card Information

Type of Access Card

Initial (Employee has never had an access card issued by Frontier to access the Collocation space.)Replacement (Lost/Stolen - Provide Existing Card Information Below) Renewal (Expired - Provide Existing Card Information Below)

Reason for Replacement

Existing Card Number

Expiration Date

Applicant Personal Information

First Name

MUST BE ALL CAPS

Middle Initial

MUST BE ALL CAPS

Last Name

MUST BE ALL CAPS

Is Applicant a U.S. Citizen?

YesNo

Alien Registration Number

Applicant Professional Information

Company Name

Manager Name

Manager Phone Number

Street Address

City

State

Zip

Applicant Job Title

Employee or Contractor

Regulated Collocation EmployeeRegulated Collocation Contractor

Regulated Collocation Access Card Mailing Address

Mailing Address (Must be the business address of the approved Secure Regulated Collocation Point of Contact)

Company Name

Attention

Street Address

City

State

Zip

Phone Number

Email Address

Photo ID Submission Required

Frontier Security requires all Access Card requests (Initial / Renewal / Replacement) to include a current photo in .jpg or .jpeg format, no hat and no sunglasses.

Photo ID

.jpg or .jpeg format only

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