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New Telephone Service

Impact of Federal and State Asbestos Regulations:

*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

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

Telephone Information

Telephone Number:	*	For office use, will be assigned by Telecom.
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.

Choose TYPE of SET:

Select the features to be included:

Other Hardware:

6' Mounting Cord is standard

Single Line Analog Set	12' Handset Cord ( $7.15 ) 14' Mounting Cord ( $2.05 ) 25' Mounting Cord ( $4.10 )
Multi-Line ISDN Set	12' Handset Cord ( $7.15 ) 14' Mounting Cord ( $12.25 ) 25' Mounting Cord ( $14.30 )

MULTI-LINE SET BUTTON ASSIGNMENTS

For larger sets, please specify any additional configuration in the comments field

Specify Ring Pattern: R=Ring, DR=Delay Ring, NR=No Ring

Comments:

Updated: 9/29/2009