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Disconnect Existing
University of Connecticut
Cellular Telephone Service

*Required

Department and Billing Information

Department Name: *
Department Head's Name:  
Has the department head authorized this request? * Approval is required.  By indicating "yes", your department agrees to pay for all charges that pertain to this request.

Contact Information

Contact's Name: *
Contact's Telephone: *
Contact's E-mail: *

Subscriber Information

Subscriber's Name:
(Name on the phone bill)		 *  First: Last:

Cell Phone/Blackberry to be disconnected:

Cellular/Blackberry
Number: 		*
Vendor: * AT&T (Cingular)
Sprint/Nextel 
Verizon
Is this a Blackberry
Device? 		  No  
Yes Blackberry service will be removed from the Blackberry Enterprise Server
Keep Please keep my Blackberry service on the server.
(Only the mobile number has been changed on the blackberry)
Reason for Disconnecting
Service:		   Service is no longer needed
Employee is no longer at UConn
Funding is no longer available
Wireless Stipend participant
Other: (Specify below in the Comments box)

Comments:

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Created: 1/15/2009