GCG Account Form
Please complete this form and fax it or hand it over to the
Office of Academic Computing
SHM C-3
Yale School of medicine
Phone:785-5181
fax:737-5796

User Name:_________________________________

P.I Name:__________________________________

Department:________________________________

Phone Number:______________________________

email:_____________________________________

Univ. Account No.:_________________________

Exp. Date:_________________________________

Billing Address:___________________________________________
 
                ___________________________________________

Business Manager's Signature_______________________________

P.I Signature______________________________________________

User's Signature___________________________________________

Date_______________________________________________________


Note: You will be contacted either by email or by phone after your account has been setup
For lab accounts please contact the office for charging instructions.