Student Affairs Illini Union

Repair Request Form

Contact Name:

Email Address:

Phone Number:

Is this a warranty repair?

Yes

No

I'm not sure

Model:

Serial Number:

Describe the Problem:

Department Name:

Room Number & Building:

Street Address:

CFOAPAL

Campus	Fund	Organization	Account	Program	Activity	Location
			147200

Student Affairs Illini Union

Illini Union

University of Illinois Urbana-Champaign

1401 W. Green Street Urbana, IL 61801

Email: iueventservices@illinois.edu