Sigma Phi Epsilon - Illinois Zeta

Patrick 411 Inc.

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Internet Access Request Form

Please complete all fields. If you need assistance please contact the Patrick 411 Inc HELP DESK

Fraternity or Sorority Name: *
Fraternity or Sorority Location (City): *
First Name: *
Last Name: *
Home Address Street 1: *
Home Address Street 2:
City: *
Zip Code: *	(5 digits)
State: *
Home Phone: *
Cell Phone: *
School Issued Email: *
Alternate Email:: *
School Issued ID#: *
Room Number: *
Computer Make / Model: *
Desktop or Laptop: *
Operating System: *
Firewall Software (if any):
Anti Virus Software (if any):
Wireless Physical Address: * (This is the MOST important part of the form. If you dont know how to find this address, please call the HELP DESK )
Comments:

Help Desk for Sigma Phi Epsilon: Please call (309) 673-1432

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