SIPA Service Request Form
Colorado Statewide Internet Portal Authority (SIPA)
Please complete the following form to request a single service from Colorado SIPA. Learn more about SIPA's services here:
https://sipa.colorado.gov/services
If at any time you need assistance completing this form, please email sipa@cosipa.gov or call (720) 409-5636.
Contact Information
Date of Request
Date Service Needed
Entity Name
Entity Type
Please select...
Municipality
County
State Agency
Metropolitan District
Higher Education
Water District
Fire District
Health District
Library District
Other Special District
Other
Street Address
City
Zip Code
Entity Website URL
Requestor First Name
Requestor Last Name
Requestor Title
Requestor Phone
Requestor Email
Please briefly describe your project goals and requirements related to this service request
How did you hear about SIPA?
Project Sponsor
The Project Sponsor has signing authority for the project. If the person requesting the service is the "sponsor" just leave this section blank.
Project Sponsor Name
Project Sponsor Title
Project Sponsor Phone
Project Sponsor Email
Type of Service Requested
I am interested in
Colorado.gov Digital Government Services (websites, payments, apps, forms)
Implementation or Consulting Services
Software Licenses
Accessibility
Cyber Security
Office Productivity
Community Engagement Solutions
Credit Card Readers
Credit Card Reader Information
How many Credit Card Readers will you need?
What make and model of Credit Card Reader(s) do you need
What are the serial numbers of the credit card readers you are replacing?
Mailing Address for Card Readers - no PO Boxes, please also provide name of person who will receive them
Colorado.gov Digital Government Services
Please select the service being requested. Each service requires a separate form to be completed.
Payment Processing - Accept credit/debit cards or electronic checks online and/or over the counter
Online forms - Engagement Builder - custom apps with the ability to take payments
Website - Colorado.gov Website
Desired website URL
please list desired URL(s) in order in the format xxx.colorado.gov
Engagement Builder Information
Is this a new instance of Engagement Builder
Yes
No
Are you adding a Sub-Tenant (new department) if so what name?
Are you adding Payments or a New Service Code?
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
What services would you like to take payments for?
Examples: Utilities, Fines, Sales & Use Tax, short term rental fees, permits, etc.
How are you currently collecting payments (manually, cashier, mail, etc.)?
What payment types do you plan to collect?
Examples: credit card, ACH, online only, with a credit card reader in the office, PayPal, etc.
Will you require integration into the state accounting system (CORE)?
Yes
No
Not sure
What is the average transaction amount?
please put a $ amount here.
Please estimate the average number of transactions per year
URL Name for Payment Service
Example: https://secure.colorado.gov/payment/GilpinCounty Please just include the text after "payment"
Will you require integration with a 3rd party provider or application (e.g. court fines, utility payments, or other software, etc)?
Yes
No
Which 3rd Party Vendor will support your payment integration if needed?
How many Over-the-Counter Devices, if any, will you need?
if none are needed put in 0.
Contact and Mailing Address for Card Readers - no PO Box, please provide name of person who will receive them
Learn more @
sipa.colorado.gov
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Contact Information