UTMB Information Services ::::: ASform

Desktop Support Program

Enterprise Services

ActiveSync Authorization Form

To receive ActiveSync access on an existing mobile device, the department must complete this form and an IRAM Request (verify minimun requirements before completing this form). There will be a one-time activation fee of $30.00. To order a new device with ActiveSync, please complete the Cellular Services Form and check the enable ActiveSync box.

Employee Information Information of the employee that will recieve service

First Name: * Last Name: * Employee ID Number: * Mobile Phone Number: * Email: * Department: *

PeopleSoft Account Information Peoplesoft Account Number to be charged

Business Unit: * Fund Code: * Operating Unit: * Department ID: * Program Code: * Class: * Project ID: * PC Business Unit: * Activity: * Budget Reference: *

Signature Authority Information Contact First Name: * Contact Last Name: * Contact Email: * Contact Mail Route: * Contact Phone Number: *

Additional Information Comments: *