Campus Facilities Management
Service Request
Mail completed form to:	GSB 101
Fax completed form to:	816-235-1355
E-mail completed form to:	CFM@umkc.edu
Date:			MoCode:
Requested by:			Account:
Department:			Chartfield Name:
Contact Name & Number:			Location of work:
Estimate Required?	Yes             No
Description:
Comments:
Please Read:
This is a request for an estimated cost and not a proposal.  There will be additional fees if design work
is needed.  Campus Facilities will inform you before any design work begins.
Telecommunications services associated with this request are not included in CFM estimates.  A
separate request will need to be submitted to Telecommunications.
If there is no activity on this request after 90 days the request will be cancelled.
Signature:			Date:
	(required)
Printed Name: