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Please select Department or Student
Departmental Need
Student/Employee Need

Contact Information
Please identify the person to provide details about the repair
Contact Name:Required Field!

38.103.63.16

Contact Phone:Required Field!
*

Contact E-mail:Required Field!
* Contact Phone CANNOT be the same as Number Being Reported
Service Location
This section pertains to the location for services you request
Department Name:Required Field!

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 Choose from List  (If NOT LISTED, BE SURE to type in below!):      
HINT:  By typing the first letter of a drop-down list, the selection will "jump" to that letter of the alphabet in the list!
       OR Type in here: 
Service Building Address:  Required Field!
  Choose from List  (If NOT LISTED, BE SURE to type in below!): 
       OR Type in here: 
  Service Rm Number:
    		Phone Number Being Reported (IF APPLICABLE) *:
  
* Report ONLY ONE phone number per repair request. CANNOT be the same as Contact Phone
Please select the general area in which you are experiencing problems
(Make sure you include details in area below)
Telephone Line/Service/Equipment
[Voice Wall Jack, Line Problems, No Dialtone, Telephone Equipment Problems]
Voice Mail/Calling Feature Problem
Cellular/Wireless Service Issues
[Cellular, Connection Card, Pager, Radio, Blackberry Problems]
Cable TV Service (Seminole CableVision)
Security/Building Access
[Access (Card), CCTV, Alarms & Monitoring Problems]
Gaming System (Register)
  Gaming System
MAC Address
Serial Number
Networking/Ethernet Problem
[VPN, Networking, Ethernet, DSL, Cable Internet, Wireless Logon, Data Line/Jack Problems]
Other (See Details Below)
Details of Repair Request ** REQUIRED **
- Please submit ONLY ONE phone number or problem per repair ticket.
- Be specific with details of repair
Required Field!

** OPTIONAL ** Department Billing Contact/OMNI Information
(IF APPLICABLE)		 ** OPTIONAL **
Budget Authorized Signature/Manager Name*:
 
Budget Manager Phone #:
  		Budget Mgr E-Mail Address:
 
*NOTE: Enter the Department Budget Representative from the Authorized Budget Signature List in OMNI.
Charges will appear on the charge detail of the phone line for that individual.
 Dept ID
(6 digits)

Fund Code
 (3 digits)

 Project
If N/A, enter 9 ZEROs;
all others enter 6-digits;
Outside Accounts, enter 3-digit OTC Acct #
Required Field!SECURITY QUESTION:
What is 2+2?

Click the Send button only ONCE!
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Questions, comments or technical difficulties regarding this form, contact otis@otc.fsu.edu

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(OTC Initials)