Request To Relocate Telephone and/or Computer Service for Employee

Use this form when moving from one location to another. Communications and Network Services Department staff will move and relocate telephone and, if requested, reconnect computer equipment. Please print this form and return it in hard-copy format to the CNS/Telecommunications Department with department head approval and signature. Please submit 5 business days prior to anticipated need.

Please provide a contact name if we have questions regarding this request:

Contact Name

Extension

Employee Name
Department
Dept. Account No.
Extension Number

Current office number:

Jack reference number in current office:

The jack reference number is located on the wall outlet where phone and computer are connected.

New office number:

Jack reference number in new office:

What is the scheduled date for move?

Please check all telephony and/or computer equipment equipment to be moved:

Telephone Personal Computer Local Printer Network Printer

Decal Number on PC

Will you need assistance in reconnecting computer and peripheral equipment? Yes No

Any additional information you would like us to know:

When form is completely filled in, print it using File, Print off menu bar at top. The form should then be forwarded to your department head for signature and mailed to CNS/Telecommunications.

Department Head Signature:

_______________________________________

Questions or comments

MCC-B364