Georgia Technical Authority 
Telephone Work Order Request
Agency -- Southern Polytechnic State University City -- Marietta, GA Agency Order No.
-- 5-__________
Building Location Room Phone
Person to be contacted
Is structural work required? Yes Is a premise visit required? Yes
No No
Description of work to be performed (Use Attachment if needed)
See description of work on following page(s) See description below
Agency Account No.   Approved(Agency Comm. Coord.) 
Date
Desired Service
FOR GTA USE ONLY --- To Telephone Company: You are to perform the service described below:
Premise Visit Requested G.S.
K.S.
Approved Date
To Be Completed by Telephone Company
Remarks: Scheduled Service Date