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New Telephone 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

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 unknown, type N/A

Choose TYPE of SET:

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)

Select ONLY the features you want to change:

If you already have a feature, you do not need to specify it below unless you want it changed.
Campus Calling  Only
Campus and Local Calling Only
Campus, Local and CT Calling Only
Campus, Local, CT and Out of State Calling Only 
Campus, Local, CT, Out of State, and International Calling Only
Campus Only after 4:30PM
Voice Mail - If you select voicemail, please insure subscriber information is filled out completely.
      Call Forwarding: No pickup forwarded to:
      Call Forwarding: Busy Line forwarded to:
Voice Mail Notification (Branches Only):  Audible (Stutter)  Visual (Msg Light) Both (Audible & Visual)
2-Digit Speed Calling
Call Pickup (List other extensions):

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

A =  R
B =  R  Outgoing calls only, unless specified to ring
C =  R  DR  NR
D =  R  DR  NR 
E =  R  DR  NR
F =  R  DR  NR
G =  R  DR  NR
H =  R  DR  NR
  I =  Auto Callback Calling
 J =  Call Forwarding Variable

Comments:


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Updated: 6/28/2007