Paging - Change Existing Service Form

CMS-BCCS Customer Solution Center

Paging Services

Instructions: Complete all information pertinent to type of requested service.

Change Existing Service Form Instructions

Agency: Agency requesting service. Required

Control Number: The agency's internal record keeping number assigned by the Coordinator for tracking orders through the procurement process. Required

Coordinator's Name: The authorized Telecommunications Coordinator. Required

Coordinator's Telephone Number and Date: The authorized Coordinator's work phone number and the date the TSR is prepared. Required

AU No.: Accounting Unit Number of agency Required

Service Changes: Indicate changes to be made from the options provided on the PSR Form.

User Information: Provide current user's name, pager telephone number, cap code, and serial number.

Note: Use the Paging Service Request Attachment Form for additional pagers

Paging Shipping Information:

If your agency is going to pick up or return a pager:
Select the appropriate box.
Provide contact name and telephone number.

If the vendor is to pick up or deliver the pager:
Select the appropriate box.
Provide a contact name and number.
Specify address where pager is to be shipped or where vendor may pick it up.

Submit Order to:

CMS-BCCS Customer Solution Center
Provisioning
120 West Jefferson - 2 nd Floor
Springfield , IL 62702
 
800-366-4784