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PA REGISTRY User Identity,
MAILBOX / MAXC / IFS Account* Application
and SECURITY ACKNOWLEDGEMENT
(Form to be filled out by Xerox Palo Alto employee only)
*Not Files-Only

User R-Name: Password:
(Preferably your last name ending with .PA) (6 or more letters and/or digits and unpronounceable)

Organization and Lab:MAILBOXGrapevine Group DLDate/by:
MAXC:
Location:explain requirement
Permanent EmployeeSummer StudentFile access only
Temporary EmployeeConsultant MAXC
Visiting ScientistFull service:
Anticipated termination date:explain requirement
File access only
CHERRYPHYLUM IVY
File storage rights
Security Acknowledgement:Date/ by:

I acknowledge my responsibility to protect any information (processed and/or stored under the above directory) which is derived from classified or proprietary company information or should be so treated under corporate policy. I understand the protection features available for this purpose provided by the Maxc/Tenex system. In addition, I will protect the directory from any unauthorized disclosure or use and I will keep my password in strict conficence.

Originator’s Name:Date:
please print
Originator’s Signature:Phone:

Supervisor’s Name:Date:
please print
Supervisor’s Signature:Phone:

Do not write below this line

User Groups:

Directory Groups:Person responsible for files in this directory if owner

File Protection:terminates:

Directory Protection:

Project Group:Disk Limit:

Remarks:


Maxc Account No.Date created:by:


Authorizing Signature:Date:

MAXC USER ACCOUNT STATUS:

ActiveInactiveTerminated
Date of Termination

Filed on [Indigo]<Forms>PARegistryAppl.Press