For GTA Use Only			Georgia Technical Authority  Phone (706)295-6067 or 1-800-653-3627  Fax (706)295-6171 TELEPHONE TROUBLE TICKET  DATE/TIME FAXED TO GTA
Ticket Number
Tech Assigned
Date/Time
Trouble taken by
CSR assigned

( Items 1 thru 4 Must Be Completed by Agency )  

1.	Name of Agency		Bldg/Room
	Address		City
	Person Reporting Trouble		Phone Number
2.	Telephone number in trouble		Type Set/ Equipment
	Description of the problem
	Contact Person		Contact Number
3.	If found to be bad, does customer want phone/equipment replaced by GTA?			Yes No
4.	This must be completed by CUSTOMER before trouble can be dispatched.
( PLEASE CHECK THE APPROPRIATE ANSWER )
Are you aware that you could either replace the equipment yourself or have GTA replace it?				Yes No
Do you want GTA to repair/replace defective equipment?				Yes No
Are you aware that you will be billed for this equipment?				Yes No
SIGNATURE OF PERSON AUTHORIZING BILLABLE REPAIR

( Below this point to be completed by GTA technician )

Trouble Found/ Corrective Action

 

Quantity	Descriptions of Billable Materials Used	Prices

Technician Billable Time Date/Time trouble cleared