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Disconnect Cellular Telephone/Blackberry 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                      Sprint/Nextel
(AT&T contract end date 10/25/09)
Is this a Blackberry Device   Yes    No 
Reason for Disconnecting Service :   Service is no longer needed
Employee is no longer at UConn
Funding is no longer available
Other: (Specify below in the Comments box)

Comments:


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Updated: 10/01/2009