Texas A&M Health Science Center - Institute of Biomedical Sciences

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Maintenance Request

Maintenance Request Form

For Physical Plant
Assignment
Work Order No.

The Texas A&M University System
Health Science Center
Institute of Biosciences and Technology
Physical Plant Facilities Department

Your email address:

Requesting Dept:

Coordinator:

Phone:

Location of Work:

Time when work can be performed:

Account Number:

Account Name:

P.I. or Dept Head Approval:

(SIGNATURE REQUIRED )

SERVICES REQUESTED: (Describe in detail. Attach extra sheet and/or sketch when necessary. Also indicate any critical
equipment involved.)

Please check appropriate box:
	Proceed without further reference to requester.
	Provide estimate only $ _____________________
	Approved for execution provided estimate does not exceed $

Do Not Write Below This Line For Physical Plant Department Use Only

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The Institute of Biosciences & Technology2121 W. Holcombe Blvd.
Houston, TX77030-3303USAVoice: +1-713-677-7700Fax: +1-713-677-7725 is part of the Texas A&M Health Science Center301 Tarrow Street
John B. Connally Building
College Station, TX77840-7896USAVoice: +1-979-458-7200Fax: +1-979-458-7202

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