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Request to qualify a device for remote access

This form is used by our team, to make sure that our clients are protected and secured. We do so by making sure that remote devices that will be used to connect to our data center, or our clients’ data, are as protected as we can realistically require them to be.

This form is required by our clients’ contractors and remote employees who use devices that Gallop Technology Group does not control, manage or protect.

Information about our client, whom you are trying to gain access TO:

Please enter the name of the company that we're hosting their data/ cloud server, and of which you are asking to gain access to.
Who will approve this request?(Required)
Name the person who you will be working with (our client's name), who we will contact to approve this request with.
The email address of the person who will approve this request.

YOUR information:

YOUR Name (The person filling in this form)(Required)
We will use your name and below Email address to communicate with you further regarding this request.
This Email will be used by our team to communicate further with you and send further information.
This number will be used by our team to send you your initial password via SMS.

About your technology:

Which device(s) will you be connecting to our client's server/ cloud data from?(Required)
Check all that apply please.
Do you have a professional IT provider maintain your computer(s) ?(Required)

We require a confirmation, and verification, of the following:
Please check all that apply. We will need to get screenshots or other proof of those confirmed statements.

Schedule a time

When can we schedule time to have one of our engineers connect remotely to confirm that your devices as secured and up to date? If confirmed, we will take this opportunity to help you set up the remote access program(s). The security confirmation process takes about 2-3 minutes per device. The setup of the remote access takes about 5-10 minutes per device. If you only need us to set up one device to connect from, as an example, it'll take about 10-15 minutes to complete, assuming the security check is completed successfully, and depends on the speed of your computer and internet speed. Note that you will be required to give us remote access using our remote support program called AnyDesk (you can read about the security of AnyDesk on www.AnyDesk.com).
Please note that this time/ date is just a request, and is NOT confirmed by our team, until you received a confirmation Email for this requested time, from our dispatchers team.
MM slash DD slash YYYY
ONE HOUR WINDOW start time(Required)
For the above chose date, please choose the start time of the ONE HOUR window in which our engineer will call you at. Must be between 9 am and 5 pm, M-F, Arizona time. We can't schedule exact time, but do our best, and normally ARE able to make these calls at the beginning of the 1-hour window.
:

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