Organization Name: (required)

Requestor Name: (required)

Email Address: (required)

Contact No.: (required)

Date: (required)

Time (12HH|MM|AM/PM): (required)
—Please choose an option—123456789101112—Please choose an option—:00:15:30:45—Please choose an option—ampm

Rack No.:

Purpose of Request: (required, check if applicable)
Site VisitEquipment Addition/Removal (Authorized Contacts only)Grant access for visitors/vendorsOthers (Please indicate here)

Granting access for visitors/vendors NOT in Authorized Contacts list:
Please indicate the appropriate access permissions to be granted for this visitation. Access may be withheld if the submitted details is inadequate or incorrect.
I hereby authorize the below visitors/vendors to:
1. Access my equipment in the datacenter:
YesNo
2. Add/remove my equipment in the datacenter:
YesNo
3. Maintain the above access permissions:
For this visit onlyFor re-entry visits on the same business day

Additional Visitor/Vendor Details (Name/Company/Contact Number):

Additional Notes:

Terms and Conditions:

1. The submission of this form does not automatically grant approval to the submitted Request.

2. Wired-Media team will review the information provided in the form submission. The Requestor will be notified of the outcome of the Visitation Request via email.

3. Upon Request approval, the access will be only valid for the stated Date of Request.

4. If an extension of the access duration is required, the Requestor shall submit the appropriate duration details under Additional Notes section.

5. For clarification, please contact Wired-Media Helpdesk at (+65) 6292-0080.

I agree to the above terms and conditions and hereby confirm that the information given in this form is true, complete and accurate.