University of Wisconsin La Crosse 
 Information Technology Services: Network Services
Campus Network Connection Request Form
(revised 9/18/03)

    Instructions For Campus Network Connection Request Form 

                Date:

 mm/dd/yy     Department:
Customer Name: Building/Room:
        Telephone:  Wall Jack No:
               Email: (the number is written on the wall jack the computer is plugged into)
           Computer Information                             Operation System (check one)                  
   Manufacturer:      
Model Number:  
Serial Number:  
Specify            Other Here:

                                                                                                                                                           

Annual User Service Fee: $90.00                  Account#:

I hereby authorize the transfer of $90.00 from the account above to Network Services, account 128/06/025805, for the Annual User Service fee for the designated network connection.           Printed Name (For Signature)   

Click on the "Prepare Form for Printing" bar just below, check your entries and if ok, print the form from that page, sign it and send it to ITS Network Services 134 Wing. Other general info is below this area. 
     

Instructions For 
Campus Network Connection Request Form

  1. Use one form per network connection.  Fill in the information above.   A person with signature authority for the account to be charged for the network fees must sign to authorize the transfer of funds. Click on "Prepare Form for Printing" and then have it signed.
  2. Return the signed form to ITS Network Services, 134 Wing Communication Center.  Questions regarding the form may be directed to 5-8031.
  3. Network Services will advise you when the network connection is complete.  Various handouts on how to use the campus network and the Internet are available in the ITS Support Center, 103 Wing, 785-8774.

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