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Enterprise Web Services

SecureWeb Site Enrollment Form

Request a SecureWeb scan for your new Website. Please provide all information requested.
Please allow five (5) business days for scan results.  Note: Scan requests will not be processed during University Holidays.
Your Contact Information

Name *

Phone *
 -  - 




Business Attributes
(Web address used when site goes live) 
(Web address used for development of the site) 
Payment Transactions   (Does your site facilitate payments?)

Sensitive Data   (Does your site process sensitive data such as SSN, Date of Birth, Driver's License #, etc.?)

(The person ultimately responsible for the content of the site) 

  Site Owner Phone (Day) *
 -  - 
  Site Owner Phone (After Hours) *
 -  - 
Technical Attributes
Website Language *  


Website User Logon    (Does the site require non-admin users to authenticate?)

(Primary person responsible for the support of the site) 

  Primary Technical Contact Phone (Day) *
 -  - 
  Primary Technical Contact Phone (After Hours) *
 -  - 

  Secondary Technical Contact Phone (Day)
 -  - 
  Secondary Technical Contact Phone (After Hours)
 -  - 
* Required