After filling out and submitting this form, please contact TR&S at 203-436-4581 or 203-436-4596 to schedule a day and time for your service. Department * Requested by * Phone Number * Authorized by * Administrator/Business Manager Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20202021202220232024 Term * Short term (< two years) Long term (> two years) Number of month(s) * Number of years * Discard Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20202021202220232024 Funding Source COA:Convert PTAEO to COA: Cut & Paste this URL to a new browser tab to do conversion https://yale-yssprod.secure.force.com/yuwd_ptaeo_fdm_conversion COA Expressed # * Terms of Contract: Requesting department agrees to pay $7.80 or ¢.65 per month for unsecured and $10.80 or ¢.90 per month for secured space and to supply COA on this signed agreement. Minimum monthly charge is $44.00. In addition, requesting department agrees to abide by set end date speciﬁed in this agreement and remove all items from storage by the end date indicated above. This $7.80 rate is guaranteed through June 30, 2020. Describe in detail items to be stored: * CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.