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Subject

Request Type

Branch Request type(optional)

Description

Priority(optional)

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Channel

Employee Name(optional)

to add loans/licenses to

Employee NMLS ID to add loans/licenses to

State(s)(optional)

Hire Date(optional)

Employee Existing Licenses(optional)

Employee Email(optional)

Phone Number(optional)

Username(optional)

Password(optional)

Specified ACES Group (if applicable)(optional)

Type of Renewal Inquiry/Category

Employee Name (from)(optional)

to add loans/licenses from

Employee NMLS ID (optional)

Employee NMLS ID to add loans/licenses from

Type of Group (team, site, job type)(optional)

Old Start Date(optional)

New Start Date(optional)

Date of LOA(optional)

Date of Return (if applicable)(optional)

Branch #

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