SIPA Service Request Form
Colorado Statewide Internet Portal Authority (SIPA)
Please complete the following form to request a single service from Colorado SIPA.
If at any time you need assistance completing this form, please email firstname.lastname@example.org or call (720) 409-5634.
Date of Request
Date Service Needed
Is there a mandated or legal requirement for this project?
Other Special District
Entity Website URL
Requestor First Name
Requestor Last Name
Project Sponsor First Name
The Project Sponsor has signing authority for the project.
Project Sponsor Last Name
Project Sponsor Title
Project Sponsor Phone
Project Sponsor Email
Please briefly describe your project goals and requirements related to this service request
How did you hear about SIPA?
Please select the service being requested. Each service requires a separate form to be completed.
Affiniti Network Assure
Call Center Solutions - Five9
Cirrus Insight - Integrate e-mail inbox with Salesforce
Custom Application Development- Custom applications that do not fit within other services
Cyber Security - Istonish or Rubin Brown
Digital Communications - Marketing Cloud or Granicus
DocuSign - Electronic Signature and Complete Digital Transaction Management
Event Registration - A solution for your event and meeting registrations. Collect payments and track registrations
Form Assembly - Online web forms that can work as a stand-alone or as a Salesforce Integration. Can include payment integration & signature.
GIS Professional Service
Google Applications - e-mail, calendar, contacts, docs, sites, drive and video.
MyEvents2Go - Mobile conference agenda solution for iOS, Android, and Windows phones
Mobile Payments - Accept credit card payments from mobile devices even if offline
MUNIRevs or LODGINGRevs
Online Video Streaming and Hosting - Granicus or Open Media Foundation
Payment Integration - Connect our payment engine to your custom application
Payment Processing - Accept credit/debit cards or electronic checks online and/or over the counter
Professional Services - Google Cloud Platform, Azure, or Salesforce Development
Rapid App Development - Online forms that might take payments
Salesforce.com - Platform as a Service, CRM and Community Management Tool, Application Development
Virtru - Email Encryption
Website - Colorado.gov Website
Other - Please contact us at 720-409-5634 or email@example.com
Please describe in as much detail as possible, the custom application's features and functions being requested?
Please describe your current method, if any, for performing this process.
Please describe how this process will be improved by the implementation of the application requested.
Who is the end user or customer for the application?
Approximately how many users will be using this application?
For what type of events and how many different events are you requesting the Event Registration Tool?
Will you be collecting payment as part of your Event Registration Process?
Payment Processing Information
Payment Processing Options - Please check all that apply
Accept Credit Cards Online
Accept Credit Cards Over-the-Counter
Accept Credit Cards on a Mobile Device
Accept Electronic Check Online
Accept Electronic Check Over-the-Counter
How are you currently collecting payments (manually, cashier, mail, etc.)?
What payment types do you plan to collect?
Will you require integration into the state accounting system (CORE)?
What is the average transaction amount?
please put a $ amount here.
Please estimate the average number of transactions per year
Will you require integration with a 3rd party provider or application (e.g. court fines, utility payments, or other software, etc)?
Which 3rd Party Vendor will support your payment integration if needed?
What Bank/Financial Institution does your organization use?
In a given year, do you expect high or low transaction periods? Please explain.
How many Over-the-Counter Stations, if any, will you need?
For Over-the-Counter transactions, what Internet Browser will your staff be using. Please list all versions in use - i.e. Internet Explorer 11, Chrome 42, etc.
Please describe your Salesforce needs
New Salesforce Application
Additional App Exchange Products
Service or Support Agreement
Please describe the solution needed - any requirements, number of licenses, timeline, alternatives, etc.
Which Google Applications are you interested in
Google Licenses (email, calendar, drive, sites, docs, video, etc.)
Google Message Encryption
Google Vault (Message Archiving)
Other Google Product (Maps, App Engine, etc)
What is your current email platform?
How many email accounts does your organization currently have?
Approximately how many licenses will you need?
Will you need help migrating from your current email platform to Google Apps?
Learn more @
Requested Website URL? www.colorado.gov/<name>
please enter the last part of the URL, e.g. /sipa
What date would you like your new site to go live?
Rapid App Development
For Rapid App Development, please
and complete the form that will send the information directly to our partner.
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