Email us if there are any questions.

New Employee Request Form

An * denotes that the Question is required before continuing

Company Information

* - Company Name  
* - City  
* - State  
    Company ID  

Contact Information To Add
Please complete the section below to grant Jack Henry and Associates the authority to add an employee record to your company.
The person listed below will have authority to conduct business with JHA.

* - First Name  
    Middle Name  
* - Last Name  
* - Email  
Preferred Communication

Authorized Caller Information

This section is solely for the purpose of Authorized Caller Privilege information for Support Cases. Please complete this section below to grant Authorized Caller Privileges.

Please Note: The contact listed has access to confidential information on your support cases. Only your employees whom you choose to have access to this information should be identified as contacts. Vendors and other non-employees should NOT be listed as a contact for your company. If you need a vendor to work directly with JHA, please have an authorized contact open a case and give JHA permission to work directly with the vendor. Understand that anyone listed as a contact or given permission to work directly with JHA has the ability to make support and CWR decisions for your company.

To grant authorizations to all products, please select one or more of the following options:

(To grant authorization on a product-by-product basis, please use the table below.)
Authorized to open Support cases on ALL products
Authorized to open Client Work Requests (CWRs) on ALL products
Authorized to approve Client Work Requests (CWRs) on ALL products

Or indicate the authorization levels for specific products by completing the information below:

For each product listed, this contact is authorized to...
Product Name Open Support cases Open CWR cases Approve CWR cases Delete
No Yes
No Yes
No Yes

If you wish to include any additional notes or comments, please do so here:

By submitting this form, I am submitting this information to JHA on behalf of the company indicated at the top of this form.

* - Name  
* - Title  
* - E-mail Address