Fiscal Services Related Items Cable/Phone Cancellation
Extended Stay -- Addendum III
Resident Name
*
First Name
Last Name
Resident Room Number
*
Telephone Services
I would like to cancel my outbound calling services
I do not want to cancel my services
Cable TV
I would like to cancel my Cable TV services
I do not want to cancel my services
Name of Signee
*
First Name
Last Name
Signature of Resident
Clear
Signature of Responsible Party
Clear
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: