WAN Service Request Form (STS01) by olliegoblue34


									                             WAN Service Request Form (STS01)                                                               Date:        /       /           Page 1

                                                                              Telephone: (919) 754-6000                         Billing Location Code (ITS Use):
                             Office of Information Technology Services
                                   Telecommunications Services                Fax:         (919) 850-2828
                                            PO Box 17209                                                                    NSWAN Site number:
                                Raleigh, North Carolina 27619-7209        SLA (ITS Use): Individual / Global

                                                                                                                            Service request number (ITS Use):
                                         ITS Home Page                       Service Level Agreement

                Please answer all questions below to expedite processing of this order. Please print or type.

Requestor Name:                                                          Requestor Daytime Telephone Number: (                       )       -

Requestor E-mail:                                                        Requestor Fax Number: (           )            -

Department Code: (billing information)          Department Name:                                            Division:

Federal ID:                                     Bill -To Telephone Number: (         )     -        (Telephone number to install DSL service)

                                                                                                            *ITS will perform this change during
    New       Termination     Change (Specify Upgrade, Relocate or Billing):                                business hours, unless otherwise specified
                                                                                                            in Remarks/Special Instructions below.
WAN:      64K         128K       256K         1.5M            3M                               L2 Metro: 100M                                Small Office
          6M           10M         20M         45M         100M                                                1G                            Broadband

QoS       Template:                                                                            Number of devices:

Site Name (Project):

Street Address:                                 City:                    County:                            Zip Code:               Room:            Wiring Closet:

Site Contact Name:                                                       Site Contact Fax Number: (             )           -

Site Contact E-mail:                                                     Site Office Hours:

Site Contact Telephone Number: (         )      -                        Contact Telephone Number: (                )           -

Site Technical Contact Name:                                             Site Telephone Number: (           )           -

Site Technical Contact E-mail:                                           Site Technical Contact Telephone Number: (                      )       -
                                                         Remarks / Special Instructions:

                                                    Customer Information and Responsibilities

•   WAN service installation occurs between 45 – 60 days from the date of the FULLY COMPLETED request form. Typical service
    termination occurs between 30 – 45 days from date of request. (NOTE: Service targets will be extended if FULLY COMPLETED
    request forms are NOT submitted)
•   Please be specific in your description of the Building and Room # (Address of Service Installation) to ensure the data circuit is
    installed within 5 feet of the rack where the router and CSU/DSU are to be placed. If information is not completed correctly, then
    service installation dates will be extended beyond 45 – 60 days.
•   Provided that a signature is on file, customers may email this form to the following address – ts.service.request@its.nc.gov
•   Customer acknowledges they have read and understood the terms and provisions in the Service Level Agreement (SLA) and
    accepts the terms and conditions as indicated.

    Fiscal Office/Budget Authorization Signature: _____________________________________________                                              Signature on File
                                          This STS01 Form supersedes all other versions.       STS01 Version (Date) 4/1/09.

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