Western Marketplace Access Form Western Marketplace Access Access Form First Name * Last Name * Universal Login ID * W# * Phone Number * Mailstop * Home Org (4 digit #) * Department * Are there any alternate delivery locations that will require frequent regular deliveries? * No Yes If Yes, Please List Alternate Delivery Locations Building Room Add Remove ROLES Please select "Shopper Only" or "Shopper/Checkout". Select Approver if it applies. * Shopper Only This person can shop and then transfer their cart to someone else for checkout. ** If this role is selected, no other access can be granted, including receiving . ** Shopper/Checkout This person can Shop and Checkout and then submit cart for Approval. Cart transferred to: * Enter the individual's first and last name Who approves the shopper's order? * Enter the individual's first and last name Will this person receive orders for others in the department? Yes No Approver? * Approver Will this person approve orders? Not an Approver Submitted by: * Date Submitted * Phone Number * Any Questions please contact Western Marketplace Support x3340 or x6341 Complete one form per individual.