Northwood Community Apartments
Students with Shared Apartments
Cable Service Change Request

Community: *

Street Name:

Street Number: *

Apartment Number: *

Apartment Phone Number (123-4567 ):

Email: *

Service Change Requested

Service Change Requested: *

Cable Cancellation

Re-Activation of Cable

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.

Requested Action Date:

As soon as possible

On a specific date

Specific date (if requested):

Enter date as MM-DD-YYYY

Resident/Roommate Information

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

Yourself

Name:

UMID:

Roommate 1

Name:

Roommate 2

Name:

Roommate 3

Name:

Northwood Community ApartmentsStudents with Shared Apartments Cable Service Change Request