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Secure File Transfer Login and Password Request Form
Please fax the completed form to (412-992-3022)
Please Note: You must have Internet access to request a Secure File Transfer login and password. Generic usernames are not permitted. Each individual accessing Secure File Transfer must have his or her own login and password. Users cannot share a login and password.
Retain Form for Your Records: For security purposes, each user will be required to recite his or her security keyword to a Systems Client Consultant for any ongoing user account administration.
Check if you have an existing username for EDGEnet
Check to disable an existing username (EDGEnet or Secure File Transfer)
Indicate existing username:________________________________
Requestor and Organization Information
(Asterisk* indicates required field)
Contact/Requestor Name*:____________________________________________________________________
First Middle Initial Last
Contact/Requestor Title:______________________________________________________________________
Security Keyword*:__________________________________________________________________________
(Examples: Mother’s Maiden Name; Name of Favorite Pet)
Firm Name*:_______________________________________________________________________________
Dealer/Group Number(s):_____________________________________________________________________
Mailing Address*:___________________________________________________________________________
City*:______________________________ State*:_________________________ Zip*:____________________
Contact Email Address*:______________________________________________________________________
Telephone Number*:__________________________ Fax Number:____________________________________
Requestor Signature*:
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