TELECMMUNICATION SERVICE REQUEST
TELECOMMUNICATION SERVICE REQUEST
NJARNGR 105-23
|FROM: (Dept/Facility) |DATE: |
| |5 June 2000[pic]5 June 2000 |
|PERSON TO CONTACT AT LOCATION: |TELEPHONE: |
| | |
|REASON FOR REQUEST: |
|(1) | New Service |(6) | Move to new location |
|(2) | Service disconnect |(7) | Service review and recommendation |
|(3) | Feature rearrangement |(8) | Directory listing |
|(4) | Additional extensions |(9) | Other (Describe below) |
|(5) | Inside moves | | |
|Date service required |
|Special requests, work details, directory and name changes, justification, other, etc. (Attach floor plan or extra sheet if necessary.) |
| |
|Printed/Typed NAME OF AUTHORIZING OFFICIAL: |SIGNATURE: |
| | |
|Submit to : NJDMAVA, CIO-TELECOM, Eggert Crossing Rd, Trenton, NJ 08625-0340 |
|TELECOMMUNICATION OFFICE USE |
|REQUEST APPROVED (Y/N) BY: |SERVICE ORDER NUMBER: |
|VENDOR: |PC/CNTL NUMBER: |DUE DATE: |CIO-TELECOM DUE DATE: |
|MATERIALS/REMARKS: |
|WORK COMPLETED BY: |DATE: |TIME STOP: |
|WORK ACCEPTED BY: |DATE: |TIME START: |
| | |TOTAL: |
|DIRECTORY CHANGES – N/Y List below old & new: |INPUT COMPLETE BY: |
|Name |Number |Dept/Org |
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