UM Housing Services - Northwood 3 Cable Service Change Request

Name(s) (include yourself and your roommates)

Exempt from Charges

Pay Equal Portion of Cost

(Yourself)

(Roommate 1)

(Roommate 2)

(Roommate 3)


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housing services: Northwood III Cable Service Change Request

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Northwood III Cable Service Change Request
Please fill out the information on this form and select the appropriate change to your cable service: Cancellation, Modification, Re-Activation.

Community
Street Number*
Street Name*
Apartment Number
Apartment Phone Number (565-4567 )
E-mail address*	(from only 1 student)

* denotes a required field

Service Change Requested (choose one:*

Cable Cancellation

To avoid charges, submit form by the first Friday after classes begin. Forms received after the deadline are subject to prorated charges.

Re-Activation of Cable

Students who previously had canceled can re-activate for a $25.00 fee in addition to the cable charges.

Modification of Billing

Residents agree to exclude one or more roommates from billing responsibility by dividing the charges among those who remain.

Resident/Roommate Information*

Complete information is required in these fields. Submit only one complete form per room, and NOT one from each roommate.

* denotes a required field