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| Custodial Work Request
Name:
Dept. Name:
Building Name:
Room #:
Phone:
Email:
Type of Work:
Moves/Setups
Replace Bulb
Shampoo/Wax
Pest Control
Clean
Other
Description of Work in Detail:
All date sensitive request must be submitted 2 weeks prior to work request, this is to ensure that your request can be met.
Please fax any drawing or diagrams to 6825
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Northwestern State University
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