Voice/Data Line Install

This form is to be used ONLY by the unit Telephone Coordinator or unit head.  To review costs see Billable Voice & Data Services.  The ITS Help Desk schedules requests on a "first come - first served" basis. Other customers' requests have been scheduled in advance, and due to the volume of requests that we receive, it may take as long as 5-10 working days to issue your order.  As well, there are times where other factors or projects on campus may cause further delays in the ordering process.  Please feel free to call us directly if you have an emergency or exceptional situation.

Fields marked with a * are required.

Telephone Coordinators Information

Name: *
Department:*
Telephone:*
E-mail:*
Account Number or Speed Code:*

Telephone Set/Data Circuit Information

Type of Telephone Number: 5-digit extension 7-digit extension
Type of Line: Digital (phone set) Analog (fax/modem/interac)
Type of Set: Single Line Multi Line Hands Free
Lan Connection: Yes No
Speed of Lan Connection: 10 Meg 100 Meg
Location to be Installed (Bldg & Rm):*
Name to be shown on Set Display (max 24 characters):*
Requested Due Date:* (ie: Monday, March 1, 2010)

Please provide us with a specific date - please do not indicate "ASAP"

Comments:

Western Directory Information

If this new phone is for a specific person, please complete the following:

FULL NAME:
UWO ID Number (if known):
Preferred Name: Title:
Job Title:
Email Address:

If this new phone is for a Frequently Used Service, please complete the following:

Name of Service:
Email Address:
URL:

Please note - Directory changes will be done when the set is installed.

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