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Move Existing Service

*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:

Current Telephone Information

Telephone Number: *
Building Name *
Room Number *
Jack Number * If unknown, type N/A.

New Location

Building Name *
Room Number *
Jack Number *
** If a New Jack is required please type in NEW and a site survey will be performed. For existing jacks the Jack Number is required.

Comments:


Please physically take the current phone to the new location.


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Updated: 9/28/2009