***Print using 10-point (12cpi) fixed font on 8.5x11 paper with 0.5" margins***

                       UofH Telecommunications Work Order
 
TELECOMMUNICATIONS UNIT                                         COMPUTER CENTER
INFO. TECH. SERVICES            TELEPHONE 4736                           CC 123
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REQUESTING DEPARTMENT                  DEPARTMENT LOCATION


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DEPARTMENT CONTACT                    CONTACT TELEPHONE NUMBER


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DATE SUBMITTED                 DATE REQUIRED             BUDGET ACCOUNT NUMBER


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                   PLEASE PROVIDE THE SERVICES INDICATED BELOW
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                     PLEASE (X)          PRESENT LOCATION     NEW LOCATION
|TELEPHONE #| INSTALL | MOVE | CHANGE | BUILDING | ROOM # | BUILDING | ROOM # |
|-----------|---------|------|--------|----------|--------|----------|--------|
|           |         |      |        |          |        |          |        |
|           |         |      |        |          |        |          |        |
|-----------|---------|------|--------|----------|--------|----------|--------|
|           |         |      |        |          |        |          |        |
|           |         |      |        |          |        |          |        |
|-----------|---------|------|--------|----------|--------|----------|--------|
|           |         |      |        |          |        |          |        |
|           |         |      |        |          |        |          |        |
|-----------|---------|------|--------|----------|--------|----------|--------|
|           |         |      |        |          |        |          |        |
|           |         |      |        |          |        |          |        |
|-----------|---------|------|--------|----------|--------|----------|--------|
|           |         |      |        |          |        |          |        |
|           |         |      |        |          |        |          |        |
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Please note, if there is no jack where a telephone is to be moved to, allow at
least two weeks for the technician to wire the location. Thank you     

Use this space for remarks or other information.

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     Mail completed order to Telecommunications, ITS via intercampus mail.
                          Please do not FAX orders.