IT Service Request Number (TASAC)

Attention: Please create an IT Request and attach this form

Email:

IT Service Request number (TASAC):

(If you do not already have an active service request, type NEW)

To order a mobile device or data plan please submit an IT Service Request and attach this form

Section 1 – USER DETAILS (How to order)
Staff Member name: / Tick to indicate New or Existing service / New □ Existing □
Faculty/Directorate: / Service number:
Campus/Building/Room: / Date required:
Section 2 – DETAILS OF DEVICE/S TO BE PURCHASED
- Contact ITD Business Support () for current devices and purchase prices
Quantity / Description of item / Price / Total
Total (incl GST) / $
COST COST CODE FOR THIS PURCHASE
GL Costing / % / Entity / Fund / Location / Department / Natural Acct
PJ Costing / % / Entity / Location / Department / Natural Acct / Category / Project
Section 3 – BILLING PLANS REQUIRED
□ I require a Voice plan.
All Phone Voice Plans are a $30 per month Plan with Data included
□ I require a Data plan.
All iPad/Modem Data plans are a $40 per month plan on a 12 month contract. Early termination fees will apply.
Casual (short-term) plans are available and pricing can be advised upon request.
COST COD COST CODE FOR ONGOING PLAN BILLING
GL Costing / % / Entity / Fund / Location / Department / Natural Acct
PJ Costing / % / Entity / Location / Department / Natural Acct / Category / Project
Section 4 – REASON FOR PURCHASE (tick all that apply)
New phone / Replacement / Lost / Upgrade / Faulty/Other
TICK BOX / TICK BOX / TICK BOX / TICK BOX / PLEASE EXPLAIN
Section 5 – BUSINESS CASE JUSTIFICATION
a.  Demonstrate how working with a mobile device will improve your work output to CQUniversity (approx. 25 words)
b.  Please list your current suite of mobile devices. Do you intend to retain all current devices or transfer any to another staff member? If so provide details.
Device type / Asset tag / Telephone number / Serial & IMEI / Condition / Transfer Y/N / Transfer Y/ N
If Yes to transfer please provide the following details. If No device will need to be returned to laTD Bld 19/1.02 Rockhampton Campus 4702
New Custodian / Location/Bld / Faculty/Directorate / Telephone number / New cost code
c.  I have been advised that a similar device is not available through the CQU redeployment pool. (Contact IT Service Desk)
d.  I have read and understood the Terms and Conditions of the CQUniversity Mobile Device Principles
Custodian signature:
Section 6 – APPROVAL DETAILS (electronic signatures accepted)
·  This form is to be completed fully and authorised by the relevant financial delegate.
·  Please note that the Custodian cannot also approve in the role of Supervisor/Financial delegate.
·  Attach this form to your TASAC Request.
IT Service Request number: / (If you do not already have an active IT service request, type NEW)
Form prepared by: / Date:
Head of Directorate Signature: / Date:
Name of Head of Directorate:
DVC/Provost Signature: / Date:
Name of DVC/Provost:
OFFICE USE ONLY:
Simcard: / IMEI: / Tasac No:
PIN: / Serial No: / Actioned by:
PUK: / Asset Tag: / Date Actioned:
Current Data Pack details confirmed with Service Provider:
(eg $15/1GB, initial and date) / MOAM Ref Number:
Sim Reburn: YES/NO

9/11/2016 v:\business_support\mobile phone information\mobile-or-data-device-order-form_v11_7 Sept 2015.doc