Student Telephone Services Request Form

All fields required.

Name (first name followed by last name)
Last 4 digits of SSN
Preferred email address
Campus Phone #	745-
Campus Address	Residence Hall Room No.

Please choose one of the following:

Increase Credit Limit:		Decrease Credit Limit:		Disconnect:
I am requesting that my Long Distance credit limit be increased to... $100.00 $150.00 $200.00		I am requesting that my Long Distance credit limit be decreased to... $35.00 $20.00		I am requesting that my long distance service be disconnected because... Authorization Code Lost Authorization Code Stolen No longer residing on campus Graduating Other (please explain)