Message Service
Order Form

Contact Department:
Contact Name:
Contact Email:
Contact Phone:
Contact Fax:
Budget/Fund/Project:
Work Order #:
	Note: Work Order numbers are not required at the time of scheduling, but will need to be provided before the date of service.
Date(s) of Service:
The following charges will be applied to the budget/fund submitted on the Work Order for each Message Service type:
	Type: Cost:  Hourly   $ 5.00  Daily   $25.00  Lunch*   $50.00/Month  Holiday**   $35.00 * Monday - Friday, noon to 1:00 p.m. **  Special holiday rate for the following Holidays: Christmas Break (with the exception of Christmas Day and New Yearâs Day) open 8:30am to 4:30pm, and Spring Break. Holidays such as Memorial Day, Labor Day and Thanksgiving Day must use the Message Service Daily rate.
Start Time:
End Time:

Messages taken for the following:
(include name, phone number, e-mail, pager number, and cell number)

Emergency Call Instructions:

Comments: