Skip to Content

Service Disconnection/Removal

*Required

Department and Billing Information

Department Name:	*
Department Number
Monthly FRS Code:	*
One-Time FRS Code:	*
UConn Campus:
Department Head's Name:
Has the department head authorized this request?	*		Approval is required. By indicating "yes", your department agrees to pay for all charges that pertain to this request.

Contact Information

Contact's Name:	*
Contact's Telephone #:	*
Contact's E-mail:	*

Subscriber Information

Change this section ONLY if you want to change how the listing appears on the monthly invoice.

Subscriber's Name: Name on the phone bill:	First: Last:
Subscriber's E-Mail:

Telephone to be Disconnected

Telephone Number:	*
Building Name	*
Room Number	*
Jack Number	*	** If a New Jack is required please type in NEW, for locations with existing jacks the Jack Number is required.

What is to be Disconnected?

SINGLE LINE SET	Desk Wall Speakerphone
MULTILINE SET	10 Button 24 Button
LINE ONLY: (No phone set)	Modem Fax Secondary Call Forward Remote
Other: (Please Specify)

Comments:

Updated: 9/28/2009