ITS - Telecom

Communication Service Request (CSR)

If you are unfamiliar with this form and need help completing it, please call 213-740-3814.

Fields that are marked with an asterisk (*) are required in order for your request to be processed.

To be completed by requesting department:

*A. Campus:**
University Park Campus	Health Sciences Campus	Other

*B. Requesting department:**
Account number*:
Communications system involved*:	5ESS Centrex Data/Ethernet Other
Requested due date:
C. Location of work to be done
Building name, room number(s), street address*

D. Work details. Please note that all work is billable, unless otherwise noted.
Telephone
Install new telephone set(s):	Yes	Quantity:
Install new telephone number(s):	Yes	Quantity:
Purchase set(s) from ITS:
Single line with speakerphone:	Yes	Quantity:
20-Button Set:	Yes	Quantity:
50-Button Set:	Yes	Quantity:
Move existing telephone set(s):	Yes	Quantity:
Change feature(s) only:	Yes	Quantity:
Change location of existing telephone number(s):	Yes	Quantity:
Completely disconnect telephone number(s):	Yes	Quantity:
Set up ITS phone conferencing:	Yes	Quantity:
Ethernet
Install new Ethernet connection(s):	Yes	Quantity:
Disconnect Ethernet connection(s):	Yes	Quantity:
Outlets
Install new outlet:	Yes	Quantity:
Quad Duplex Single
Tone and Grid Outlet:	Yes	Quantity:

E. Please explain the details of the work you need to be done: (Be sure to include the 10-digit wall jack/outlet number, if available):
Submitted by*: (Name and title)
School and/or department*:
Phone*:
Email*:

Last updated: Wednesday, August 06, 2008, 15:14PM PDT