• All changes must be received by the 15th of the month in order to be processed during that billing period.
• If more than one account number change is being requested, please submit another form.

* indicates required fields

Will this change be charged to a Banner Non-Grant Index or Grant Index?

Grant *
Non-Grant *

Contact Person
- This is the person to contact with questions regarding this request.

Person Authorizing the Request.
- This is the person with budget authority (for example, a Director).

Contact Person same as Person Authorizing Request
Clear Authorized Person Information

Billing Information Changes.
Choose the service(s) that apply. Be sure to complete the billing information changes for each of the chosen services.

Do you need to request changes to billing information on phone extensions?

No.
Yes. (If yes, please complete this section.)

Enter Extensions Here:

Do you need to request changes to billing information on specialized phone lines?

No.
Yes. (If yes, please complete this section.)

Choose the specialized line type that applies

BellSouth Line
Paetec Line (800 Service)

Enter the 10-digit phone numbers of the specialized lines here:

Do you need to request changes to billing information on cellular phones?

No.
Yes. (If yes, please complete this section.)

Enter the 10-digit cellular phone numbers here:

Do you need to request changes to billing information on calling cards?

No.
Yes. (If yes, please complete this section.)

Enter the calling card numbers here:

Additional Details.
Enter any additional comments, details, or questions based on your request.