Service Cancellation Request Form t

Service Cancellation Request Form
All forms must be completed with original signatures and sent to:
ITCS, Mail Stop 669 HS Telecom, Brody 1S10
Attn: RaShawna Perry 744-1848 Eric Hunnicutt 744-0339
Department: _______________________________
Date of Request: ___________________________
User Last Name: ___________________________
User First Name: ___________________________
☐ Pager
Pager Phone Number
☐ Cellphone
Cellphone Phone Number
☐ Wi-Fi Device
Broadband Phone Number
☐ iPad
iPad Phone Number
Reason for Cancellation: _____________________________________________________________________
Department Head (cannot be the user) __________________________/__________________________/___________
(Print Name)
*All pagers not being used should be returned to ITCS Telecommunications department located at Brody 1S10 or a fee
up to $100.00 can be applied to the issuing departments FOAPA. All Device(s) must be returned to the issuing
department upon request from the department, transferring to another department, or separation from the University.
Failure to return the device(s) to the University may constitute as misuse or theft of University property, and may result
in disciplinary action and/or criminal charges
Revised June 2015