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GAPS PRODUCTION SYSTEM <br /> EXTERNAL USER ACCESS REQUEST FORM <br /> Organization Name: <br /> SECTION I: DUNS No. Tax ID No. EIN No. <br /> Is this user a Servicer? [ ] YES [ ] NO (Mark only one with an "X") <br /> If you checked "Yes" above for a Servicer, please give the Servicer address <br /> and phone number. <br /> Address: <br /> Phone: <br /> SECTION II: User Name: DOB: <br /> (Last) (First) (MI) (for verification purposes only) <br /> User Signature: Telephone No: <br /> Internet Address: <br /> (Official address for ED electronic correspondence) <br /> User's E -mail: <br /> User's Social Security Number: <br /> (Social Security Number on this form is voluntary, but failure to do so may result in being denied <br /> access to GAPS. Social Security Number will only be for verification purposes.) <br /> SECTION III: USER ACKNOWLEDGEMENT AND ACCEPTANCE OF RESPONSIBILITIES: <br /> a) Know the sensitivity of the information processed in GAPS which is financially sensitive <br /> and privacy sensitive. <br /> b) Protect sensitive information from access by, or disclosure to unauthorized personnel. <br /> c) Create and use a combination of alphanumeric character passwords and do not disclose <br /> your password to anyone. <br /> SECTION IV: AUTHORIZATION: <br /> Authorized By: Title: <br /> Signature: Date: <br /> Telephone Number: <br /> • <br /> • <br />