Employee Contract Form - State University of New York at Oswego
Employee
(All rates are subject to change with 30 days notice)
10/2013 SAS
SUNY Oswego
CTS-Telecommunications Office
Contract for Employee Business/Personal PBN
PLEASE PRINT CLEARLY
Name
___________________________________
Campus ID #
____________________________________
Dept. Name__________________________________ Home Address:
Dept Billing #_______________________________ Street Address __________________________________
Building _____________________ Room #_______ City/State/Zip __________________________________
Private Ext# __________Published Ext#___________ Home Phone #_________________________________
SUNY Oswego Email Address_____________________[email protected]oswego.edu
Laker NetID: ______________________
You must notify our office of any change(s) of address, campus or home.
This form is a contract for a confidential Employee Department and/or Personal 7-digit PBN (Personal Billing Number). A PBN is needed to
make any off-campus calls, including local, long distance, and toll free calls.
To obtain a Department PBN our office must have written authorization from your department’s chairperson. {Please refer to #1 on reverse
side}.
You may disconnect your PBN at any time, providing you submit written notice to the Telecommunications Office. Deactivation will be made
promptly.
Please select any of the following that apply to you:
□
Applying for new PBN
□
Returning employee
□
Changing departments
□
Split position requiring an additional dept. PBN
□
Have an existing Department PBN ---- If so, which department(s)? ____________________________________________________
Please select which PBN (s) you are applying for:
□
Department PBN: _______________________
□
Personal PBN: _______________________
~~~~~~~~~~~~~~ACKNOWLEDGMENT~~~~~~~~~~~~~~
I have received and read the terms and conditions, stated on the back of this form, and agree to assume full responsibility for
all charges, calls, and taxes incurred. In addition, I assume responsibility for the use of any services that I have requested.
Upon receipt of the monthly email notifications, I agree to render payment by the due date specified on the telephone
statement. Any past due balances MUST be paid in full before my application for services will be processed.
Employee Signature: ___________________________________________________ Date: _________________
I hereby authorize the above named employee to receive a PBN to be billed to the department function number stated above.
Dept. Chairperson or Supervisor Signature: _________________________________ Date: _________________
For office use only:
Updated in Pinnacle Subscriber ID: _______________________
Updated in Web Portal
Updated in Cisco Employee Initials ______ Date __________
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