Organizational Information (Requestor/Contact) Division Telecommunications Coordinator (DTC) Contact (Should be different from DTC ) Badge Number E-mail Note: Please 3-5 business days to complete most Requested Completion Date requests. Service Requested (Customer and Billing) User Name Badge Number E-mail Current Room Nearby Number (Order cannot be accepted without Charge Number this information) Telephone Services If there is not a telephone jack in the room, new wire will have to be pulled IMPORTANT: Is there a Jack in the room? Yes No (separate form required). Please place note on the wall where the jack is to be If so, Jack Number: located. Move From (Bldg./Rm.) To (Bldg./Rm.) New Number will be New Set will be Customer will provide set. No set will be required (Indicate required required Type (Indicate Reason Below) STANDARD WITHOUT SPEAKER MERLIN (**Template required) FAX ONLY SPEAKER TELEPHONE LSI (**Template required) ONLY 2-LINE WITH SPEAKER ISDN (**Template required) Addition 2-LINE WITHOUT SPEAKER NORSTAR (**Template required) 3-LINE WITH SPEAKER OTHER: 4-LINE WITH SPEAKER **Templates available on the website @ Equipment Preference Yes No If yes, specify Manufacturer and Model Number Number being disconnected Bldg. # Rm. # Disconnect Note: If the line being disconnected has extensions, they will also be removed. If known, please give the location/s below. Location of Main Number Bldg. # Rm. # Location where extension is to be Bldg. 1/Rm. # Bldg. 2/Rm, # Bldg. 3/Rm. # Add New Extension added Extension New set will be required (Indicate Type below) OR Customer will provide set. (Indicate Type Below) Manufacturer Model Number Location extension is to be Bldg. 1/Rm. # Bldg. 2/Rm. # Bldg. 3/Rm. # Remove Existing removed Extension Note: When an extension is disconnected, the installer will pick-up the telephone set. Add Equipment Equipment Type Bldg. # Rm. # Remove
Organizational Information (Requestor/Contact) Division Telecommunications Coordinator (DTC) Contact (Should be different from DTC ) Badge Number E-mail Requested Completion Date Note: Please 3-5 business days to complete most requests. Service Requested (Customer and Billing) User Name Badge Number E-mail Current Room Charge Number Nearby Number (Order cannot be accepted without this information) Telephone Services IMPORTANT: Is there a Jack in the room? Yes No If so, Jack Number: If there is not a telephone jack in the room, new wire will have to be pulled (separate form required). Please place note on the wall where the jack is to be located. Move From (Bldg./Rm.) To (Bldg./Rm.) Addition New Number will be required New Set will be required Customer will provide set. (Indicate Type No set will be required (Indicate Reason Below) STANDARD WITHOUT SPEAKER SPEAKER TELEPHONE 2-LINE WITH SPEAKER 2-LINE WITHOUT SPEAKER 3-LINE WITH SPEAKER 4-LINE WITH SPEAKER MERLIN (**Template required) LSI (**Template required) ISDN (**Template required) NORSTAR (**Template required) OTHER: **Templates available on the website @ FAX ONLY ONLY Equipment Preference Yes No If yes, specify Manufacturer and Model Number Disconnect Number being disconnected Bldg. # Rm. # Note: If the line being disconnected has extensions, they will also be removed. If known, please give the location/s below. Extension Add New Extension Location of Main Number Bldg. # Rm. # Location where extension is to be added Bldg. 1/Rm. # Bldg. 2/Rm, # Bldg. 3/Rm. # New set will be required (Indicate Type below) OR Customer will provide set. (Indicate Type Below) Manufacturer Model Number Remove Existing Extension Location extension is to be removed Bldg. 1/Rm. # Bldg. 2/Rm. # Bldg. 3/Rm. # Note: When an extension is disconnected, the installer will pick-up the telephone set. Equipment Add Remove Equipment Type Bldg. # Rm. #
Telephone%20Request%20Form.docx