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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:

Updated: 6/28/2007