FlyPDX - Security Access Change Request

This form must be completed by an Authorized Signatory or a Port of Portland representative to request additional access for a PDX security badge.
*If you are unsure of who your company’s Authorized Signatory is, check with your employer or contact the Badging Office at 503.460.4500.

I verify that I am an Authorized Signatory or Port Representative:

Step 1
Step 2
Step 3

Your Information (Info for person completing this form)

First Name

Last Name

Company Name or Port Department

Phone

Confirm Email Address

Badgeholder Information (Info for person(s) for which this request is being made)

First Name

Last Name

Company

UPID

Access Change Request

Door Number(s) / Area Requested

Duration of Request
For Duration of Employment Between Selected Dates

Start On

End On

Justification for Additional Access
Please provide a detailed description of the operational/business need

Click the checkbox to prove you are a human