UNIVERSITY OF PITTSBURGH \ FORM INSTRUCTION GUIDE



FORM TITLE:         NETWORK ATTACHMENT REQUEST
NUMBER:             FORM 0023
PROCEDURE:          10-02-13


*    Complete  a separate form for each port location  (room  and
     building).
*    Shaded areas to be completed by CIS.

_

ENTER THE FOLLOWING INFORMATION, WHERE INDICATED:

    1.    Requester's Name (Last, First, Middle Initial  -  Limit
          to 39 characters)

    2.    University  Personal Reference (PR) Number (PNNNNNNNNN)
          from the reverse side of the University ID Card

    3.    Campus Address (For building abbreviations refer to SPI
          9)

    4.    Campus  Telephone  Number,  including  area  code  (3),
          telephone  number (7), and extension (4) if  applicable
          (AAA-NNN-NNNN-XXXX)

    5.    Electronic  Mail Address (EMail), your VAX/VMS  Cluster
          Username

    6.    School/Responsibility Center

    7.    Department

    8.    Signature of Requester

    9.    Date of Signature


_
REQUEST INFORMATION

   10.    Quantity   of  attachment  devices  desired   on   line
          corresponding to type of Network connection desired

   11.    Rates included on Exhibit A to be completed by CIS

   12.    Port Location (Room and Building)

   13.    Desired   location   of   port(s)   (physical   network
          attachments)  within  the room  (Attach  a  diagram  if
          necessary)

_

INSTALLATION AND ACTIVATION CHARGE INFORMATION


   14.    Printed name of FAIS Account Administrator (Limit to 39
          Characters)

   15.    University  Personal Reference (PR) Number (PNNNNNNNNN)
          from the reverse side of the University ID Card

   16.    Campus Telephone Number, (AAA-NNN-NNNN-XXXX)

   17.    FAIS Account Number (L-AAAAA-SSS)

   18.    Electronic  Mail Address (EMail), your VAX/VMS  Cluster
          Username

   19.    FAIS Account Administrator's Signature

   20.    Date of Signature


_

MONTHLY ACCESS CHARGE INFORMATION

   21.    Printed name of FAIS Account Administrator (Limit to 39
          characters)

   22.    University Personal Reference (PR) Number (PNNNNNNNNN)

   23.    Campus Telephone Number (AAA-NNN-NNNN-XXXX)

   24.    FAIS Account Number (L-AAAAA-SSS)

   25.    Electronic  Mail Address (EMail), your VAX/VMS  Cluster
          Username

   26.    FAIS Account Administrator's Signature

   27.    Date of Signature