RTS: Our Priority is getting you connected
Communication and Network Services
2484 Shattuck Avenue
Berkeley, CA   94720-1640

Cancellation Request

 Phone:   510-643-7000
FAX:      510-643-7046
Email:    rts@berkeley.edu

This form is to be used ONLY if you will be moving out of your residence and for Individual Authorization Code cancellation.
Cancelling your Individual Authorization Code does not relieve you from paying the mandatory service fee.

Residence Telephone Services      

Effective Date: 

SID #: 

Name: 

E-mail: 

Residence Hall: 

Room #: 

Telephone: 

Close My Account and Cancel All Services because I am moving out.
OR

Maintain Account, but Cancel the Following

IAC 

                                 Reason for Cancelling:

New Forwarding Address:
Street Address: 
City:  State: 
Zipcode: 
Country:      Telephone #: 

You will receive a confirmation of this completed form via e-mail

By submitting this form you agree to abide by all the rules and regulations as stated above.

Date:    

    Please Note:  Although it is most unlikely that you will experience any problems responding to this form,

    certain non-standard browsers will not respond properly. If you experience any difficulties, or if you are   

    not using a forms capable browser, you may email your reponse to: rts@berkeley.edu     

                   

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