Customer Request Number
1. Date:
CUSTOMER REQUEST
California State University, Fresno
Mail# PO140
3. Building Name:
4. Room Number:
5. Department:
6. Requestor:
7. Contact Person:
8. Phone Number/Mail#
9. Work should completed by:
10. Department Approval:
INSTRUCTIONS TO REQUEST SERVICES
1) Complete all parts of the form clearly and completely. Incomplete service requests may delay pro-
cessing.
2) Submit the service request as soon as possible to ensure ample time for planning, scheduling, and
completing your request.
3) If you have questions while completing this form, contact us at (559) 278-7422 and we will be
happy to help.
Chargeback: If your request for service may result in a chargeback to the department, you will
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required on all chargeback services.
2. Description of service request
Instructions to complete the form is provided below.
11. Contact Email: