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Network Services Enterprise (NSE) — Telephone Line Request - Lineholder

Please note: This form will request a new phone line and make you responsible for the installation fee, as well as the monthly service costs.

If your roommate has already filled out this form, you need the shorter form to apply for a long distance code.

*Please provide the following information: (an denotes required fields)**
First name:	*
Last name:	*
Provide a telephone number where we can contact you or leave a message:	*
Your e-mail address where you can be contacted:	*
I am		a Student (charges will be billed through the Bursar) Faculty / Staff (charges will be payroll deducted)
Your plus number:	*	Example: +12345678
Permanent home address:	*	Street: City: State: Zip:
Home telephone number:	*
Service Installation Information:
Service address where the phone is to be installed:	*
Room or apartment number:
If known, previous telephone number that was at this address:		How do I find the number?
Desired installation date (please allow 7-10 business days):		(mm/dd/yyyy format) Appointments are first come, first serve. We cannot promise that we will be able to schedule the date you request.
Will this be an additional line?		Yes No
Do the jacks need to be rewired, or new jacks to be installed?		Yes No

Please indicate which of the following services you would like to have installed:
		New off-campus telephone line. (Note: If you don't want this, you are using the wrong form.)
		Miami University Campus Operator Directory Listing. No additional cost.
		Miami University Authorization Code. No additional cost. (Note: Each roommate must sign up separately.)
		Cincinnati Bell Wirecare service $5.95 per month.
		Cincinnati Bell Collect Call Blocking no charge upon request.

Before you click 'Submit': Read This - It's about your money:

You must cancel or transfer your service when you leave the address. Otherwise you will be paying for a phone line you're not using.
You can cancel your service by completing the Phone Line Disconnect Request form on-line.
You will be billed for any extra charges that may appear on the account (like collect calls).
You agree to make your payments in accordance with the Bursar's standard policies.
You agree to all the Terms and Conditions of use.
Please understand that failure to pay will result in your service being cut off (subject to a reconnection fee) and being subject to normal University policy regarding non-payment of obligations.
Please Note: While no rate increases are expected, rates are subject to change without notice.
Miami Univeristy receives compensation when providing this service. Please consider your needs and financial capabilities carefully when you are determining whether to purchase this service.

I have read all of the above information and agree.

These services are offered by Miami University Network Services Enterprise in cooperation with Verizon.

Support Information:

Service Address: This must be an EXACT address, within 3 miles of the Verizon Oxford office. The Verizon Oxford office is near the intersection of Church Street and Beech Street, around the corner from the Princess Theatre.

Plus Number: This number is issued by Miami University for record keeping. You can find your Miami University Plus number on the "Telephone Charges" statements we send, or on your Bursar statement.

Collect Call Blocking: This service will prevent anyone from receiving collect calls to this phone. This can help keep unwanted charges off your phone bill.

Campus Operator Directory Listing: The University campus operators have a separate listing from Verizon which is free to lineholders and roommates.

Cincinnati Bell Wirecare : This service pays for maintenance if the wiring for your line develops a problem. It does not help reduce the costs of getting the line installed.

For additional information, or assistance in completing this request, please call us at (513) 529-8774 or send e-mail to NSE@muohio.edu.