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Cellular Service Request

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					                                                                                                                                           Date:                  Page:
                                             Cellular Phone Service Request
                              Office of Information Technology Services         Phone: (919)754-6708 or (919)754-6724                      Start Date:
                                    Telecommunications Services                        Fax to:       (919)-981-5138

                                       4110 Mail Service Center                       ITS Home Page Web Address:                           Requested Due Date:
                                  Raleigh, North Carolina 27699-4110                     http://www.its.state.nc.us

                            Agency (Optional):                                 Service Request Number (ITS Use):                           Bill-To Number (Optional):


                    Please answer all questions below to expedite processing of this order. Please print or type.
Requestor Name:                                                        Requestor Telephone Number:                 (           )             -             EXT:


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

Federal ID:                               Billing Location Code (ITS Use):                           Service Location :

Department Code:                          Department Name:                                                     Division:


Street Address: (Physical Location):                            City / Town:                                   Zip Code:                    County:

                                                                    Type of Service:

        New           Cancellation          Repair / Replace            Change to State Contract                   Accessories Only                      Lost / Stolen
                                                                   Vendor of Choice:
                         Alltel        AT&T          Nextel               SunCom             US Cellular                   Verizon Wireless

         Employee Name                    Cellular Equipment Type                 Cellular Number (Assigned New)                   Cellular Number (Existing)

                                                                                  (      )       -                                 (         )      -


                                                                                  (      )       -                                 (         )      -


                                                                                  (      )       -                                 (         )      -

                 Cellular Accessory Orders (Description)                                 Quantity              Cellular Number

1                                                                                                              (           )           -

2                                                                                                              (           )           -

3                                                                                                              (           )           -

                                                          Describe the Service Request.




Justification:




Budget Officer’s Signature (Mandatory):                               SOF             Telephone: (         )           -                         Date:
                                   This form supersedes all other versions.    Cellular Service Request.       Version Date (4/29/03)

				
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