Communication Technologies - North Carolina State University

516 Brickhaven
Box 7208
Raleigh, NC 27695-7217
Phone: 919-515-7099
Fax: 919-515-5164

Network Operations
Phone: 919-513-9675
support@ncstate.net

ComTech > Service Requests

Please fill out the fields specified below.

Campus ID Number : (not applicable to Post-Docs)

( found on Campus ID card )

Resident Type :

Student: Post-Doc:

Last Name :

First Name :

Building :

Apartment # :

Phone Number:

( cellular phone, etc )

Email Address:

Permanent Address:

Package Selection:

Package 1	$18.00 / month Local Phone Service Only
Package 2	$25.50 / month Local Phone Service Voice Mail Call Waiting
Package 3	$36.00 / month Local Phone Service Voice Mail Call Waiting Call Return Caller ID 3-Way Calling

*Note: A $100 service connection fee applies to these packages.

Service Start Date:

( YYYY-MM-DD )

Service End Date:

( YYYY-MM-DD ; if known )

Policy Agreement:

I have read and agree to comply with the Terms and Conditions:
Yes No

Application Submittal Date:

2009-11-23