IT Communication Services New Phone Service Section 1: Requestor Information __________________ Email: __________________
Requestor Name: ____________________________ Requestor Contact No:
Section 2: Employee Information Employee Name: ________________________________________ Job Title: ___________________________________________ A_Number: ______________ Supervisor Name: _____________________________Supervisor Number: ____________________ Department: _____________________________________ Department Head: _________________________________________ Email Address: _____________________ Employee Status: Staff Faculty Full Time Part Time Temporary Employee's Name to be displayed on caller id ________________________________ Section 3: New Phone Service New Mitel Phone Building & Room Number: ___________________________________ New Fax Building & Room Number: ___________________________________ Is there a phone jack in this location? Yes No Not Sure Is voicemail needed with this new phone extension? Yes No Add extension ______________________ to new extension __________________ Ring No Ring Add extension ______________________ to new extension __________________ Ring No Ring Change current name ___________________________on extension: _______ to new name__________________________ Section 4: Billing Information Department Number or Grant FOAPAL for Phone Service Charges: FOAPAL: Fund _______________ Organization _________________ Account _______________ Program_______ Grant Funding: Yes No Name of Grant: __________________________________ Funding Dates: ____________________________ Section 5: Approvals Requestor (Print) (Signature) Budget Manager (Print) (Signature) Dept. Chair/Dean/Director (Print) (Signature) (Date) (Date) (Date) Please fax signed form to 256‐372‐5957 or deliver to New School Business, Room 306. ITS Communication Services Use Only Assigned Phone Number: __________________ Type of Phone: _______________________ Ticket # ____________ Assigned Fax Number: _________________ITS Representatives: ______________________ ______________________ Billable Amount (parts & labor): ___________________________ Date Completed: _____________________ Rev 071014