LA1ELECTRIC

Service Request Form

Please select an option:*
Internal Ticket Number:
Accounting Unit:
Ticket Creator Name:*
First Last
Ticket Creator Telephone Number:*
Ticket Creator Email*
Location Information:*
Street Address Address Line 2 City State ZIP Code
Does this ticket require escalation?*
- Non-Emergency
- Emergency
Requested Completion Date & Time:*
MM slash DD slash YYYY
*

: Hours

Minutes

AM/PM
Approving Manager Name:
First Last
Approving Manager Telephone Number:
Approving Manager Email Address:
Please upload any supporting files below:
Max. file size: 512 MB.
Brief Description*