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VITA/IT Infrastructure Partnership
COV Account Request Form

COV Network Account Request
Account request selection:
Agency:        
Effective Date for Request:     Requests greater than five (5) business days in advance are unable to be processed. Please submit the request within five (5) business days of the desired effective date.
Type of Request:  
First Name:    
Middle Initial:    
Last Name:    
Phone:    
Ext:  
Address:    
City:    
ST:    
Zip:    
Manager's First Name:    
Manager's Last Name:    
Manager's Email Address:    
Manager's Phone:    
Manager's Ext:  

Requester's First Name:    
Requester's Last Name:    
Requester's Email:    
Requester's Phone:    
Requester's Ext:  
Requests cannot be sent directly to the VITA Customer Care Center or to non-agency or VITA/NG partnership email addresses from this website. All provided email addresses must be your agency’s ISO, AITR, and/or Designee.
Agency Approver's Email 1:    
Agency Approver's Email 2:    
Agency Approver's Email 3:    
Agency Approver's Email 4:    



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