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Document identity
localId
26083463
label
Telecommunications Service Request Form
core
doc
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document
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1
Source metadata
id
26083463
sourceUrl
contentType
document
title
Telecommunications Service Request Form
citationUrl
collections
Records of the First Lady's Office (Clinton Administration)
Eric Woodard's Files
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Source extras
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26083463
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otherTitles
42-t-7422555-20140780S-005-012-2015
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description
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nara-archive
Single page context
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1
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49e966a9a14d4845
ocrText
MODEL NAME:
ISON 06207
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DEPT. COORDINATOR:
PROJECT MANAGEMENT SPECIALIST:
CUSTOMER APPROVAL:
AGENCY NAME:
DATE:
Executive Office of the President
Office of Administration
TELECOMMUNICATIONS SERVICE REQUEST
Send to: Telecommunications Service Office (TSO)
TSO MAIN NUMBER X6-6400
Current Date
OEOB, Rm. 019 Fax Number (202) 456-9800
For assistance completing this form, call x6-7294.
For technical assistance completing this form, call x6-6400.
Requestor's Name (Print)
Agency
Bldg./Room No.
Phone No.
Requested For
(Print)
Agency
Bldg./Room No.
Phone No.
Requirements
(Briefly describe requirement(s), then check or designate all that apply.)
Date Required
Install*
Move*
Change
Disconnect
"Attach floor plan
ESTIMATE REQUIRED:
Check here if you wish to receive an estimate before the job is started.
QTY
ITEM DESCRIPTION
Y N RESTRICTIONS
10 Button Phone Set
Receive incoming calls
20 Button Phone Set
Make outgoing calls
Telephone Line(s)
Make local calls
Make long distance calls
Make international calls
Other
(Specify)
CONTACT INFORMATION
Name (Print)
Bldg./Room No.
Phone No.
TELECOMMUNICATIONS REPRESENTATIVE AUTHORIZATION
Name (Signature)
Bldg/.Room No.
Phone No.
Date
Name (Print)
FUND MANAGER
Name
Bldg./Room No.
Phone No.
Date
Signature
BAC Code (i.e., 23, 66 etc)
TSR No.
OA FORM 67
Revised 10/95
MODEL NAME:
AT&T
Manu
or
(Anr
Medy
0
Message 0
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1 3
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like
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of
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5
0
Spector
EXP
121
TW
7 8
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0
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HoM
*
Project Management Specialist:
Department Coordinator:
Agency Name:
Customer Approval:
Date: