eSelect Username & Password REVOKE Form
Click Here To Request An eSelect ID
If an employee leaves your agency, you should have their userids and passwords deactivated as soon as possible. Fill out the form below, so that we can proceed with this immediately.

Subject: eSelect Username & Password REVOKE
To: eBusiness Rep   <eRequest@selective.com>
* Your Name:
* Your Email:
* Agency Name:
* Agency Code:
* Phone:
Access to CLAS:
Access to SelectPLUS:
User Names and/or ID's to revoke (separated by commas):

* indicates required field
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