Atlassian uses cookies to improve your browsing experience, perform analytics and research, and conduct advertising. Accept all cookies to indicate that you agree to our use of cookies on your device.
Atlassian uses cookies to improve your browsing experience, perform analytics and research, and conduct advertising. Accept all cookies to indicate that you agree to our use of cookies on your device. Atlassian cookies and tracking notice, (opens new window)
Use this form to request a new connection from Q-Life.
Required fields are marked with an asterisk*
{"xsrfToken":"26619ea820d3b0b86e4b4bd228361557f8bcd826_lout","branding":{"id":"1","key":"sr","name":"Service Request Portal","portalBaseUrl":"/servicedesk/customer/portal/1","logoUrl":"/rest/servicedesk/1/customer/viewport-resources/portal-logo/1/2","theme":{"headerBGColor":"#ffffff","headerLinkColor":"#292929","headerLinkHoverColor":"#186473","headerLinkHoverBGColor":"#186473","headerBadgeColor":"#186473"}},"helpCenterBranding":{"logoId":"","isLogoAvailable":false,"helpCenterTitle":"Welcome to the QLife Network Help Center","sharedPortalName":"QLife Network Help Center","userInitialAnnouncementHeader":"Report an Outage","userInitialAnnouncementMessageWiki":"<p>If you are experiencing an outage, please call (541) 370-2690.</p>","translations":{"en-US":{"helpCenterTitle":"Welcome to the QLife Network Help Center","sharedPortalName":"QLife Network Help Center","announcementHeader":"Report an Outage","announcementMessage":"If you are experiencing an outage, please call (541) 370-2690.","localeDisplayName":"English (United States)"}},"canEditAnnouncement":false,"siteDefaultLanguageTag":"en-US","userLanguageTag":"en-US","portalThemeColor":"#7a2818","helpCenterTitleColor":"#ffffff","bannerMediaApiUrl":"https://api.media.atlassian.com/file//image/cdn?token=eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI1YTU0M2I1Zi04NDM5LTRiYjEtOTJkYy03NzZmMDc4YjJiZTQiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpmaWxlOiI6WyJyZWFkIl19LCJleHAiOjE3ODQzNTU0NTYsIm5iZiI6MTc4NDM1NDg1Nn0.kjFruq_elg2kYQ7hlSvqTfdPgnNlcp_uJZBgLsp2trg&client=5a543b5f-8439-4bb1-92dc-776f078b2be4&height=300&mode=fit","bannerMediaApiFileId":"","useDefaultBanner":true,"isBannerAvailable":true,"topBarColor":"#7a2818","topBarTextColor":"#ffffff","hasTopBarBeenSplit":true},"portal":{"id":"1","key":"sr","projectId":10000,"serviceDeskId":1,"name":"Service Request Portal","description":"<p>Welcome! You can raise a request for Service from QLife using the options provided. If you are experiencing an outage, please call (541) 370-2690.</p>","portalBaseUrl":"/servicedesk/customer/portal/1","onlyPortal":false,"reqTypes":[{"id":"2","name":"General Question","descriptionHtml":"","callToAction":"General Question","introHtml":"<p>Question about Q-Life Connections</p>","icon":10549,"iconUrl":"https://q-life.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10549","groups":[2],"key":""},{"id":"14","name":"Issue with Q-Life Services","descriptionHtml":"","callToAction":"Issue with Q-Life Services","introHtml":"<p>Need help installing, configuring, or troubleshooting? Select this to request assistance.</p>","icon":10520,"iconUrl":"https://q-life.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10520","groups":[2],"key":""},{"id":"4","name":"Request a Quote","descriptionHtml":"<p>Use this form to request a new connection from Q-Life.</p>","callToAction":"Request a Quote","introHtml":"<p>Submit a request for a quote for a new service location using this form.</p>","icon":10536,"iconUrl":"https://q-life.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10536","groups":[2],"key":""},{"id":"10","name":"Emailed request","descriptionHtml":"","callToAction":"Emailed request","introHtml":"<p>Request received from your email support channel.</p>","icon":10527,"iconUrl":"https://q-life.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10527","groups":[],"key":""},{"id":"48","name":"Maintenance","descriptionHtml":"","callToAction":"Maintenance","introHtml":"","icon":10472,"iconUrl":"https://q-life.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10472","groups":[],"key":""},{"id":"8","name":"Request a review","descriptionHtml":"","callToAction":"Request a review","introHtml":"<p>Need a contract, legal, or security review? Submit a request here.</p>","icon":10523,"iconUrl":"https://q-life.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10523","groups":[],"key":""},{"id":"6","name":"Request deal support","descriptionHtml":"","callToAction":"Request deal support","introHtml":"<p>Need help to close a deal? Submit a request here.</p>","icon":10513,"iconUrl":"https://q-life.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10513","groups":[],"key":""}],"reqGroups":[{"id":2,"name":"General"}],"orderMapping":{"2":[14,4,2]},"kbs":{"kbEnabled":false,"serviceDeskId":-1},"createPermission":true,"portalAnnouncement":{"portalId":1,"canEditAnnouncement":false,"canAdministerProject":false,"portalProjectKey":"SR","userLanguageHeader":"Billing Portal Link","userLanguageMessageWiki":"<p>Access our <a href=\"https://nwascopud.smarthub.coop/ui/\" class=\"external-link\" rel=\"nofollow noreferrer\" target=\"_blank\" style=\"text-decoration: underline;\">Billing Portal</a></p>","defaultLanguageHeader":"Billing Portal Link","defaultLanguageMessage":"Access our [Billing Portal|https://nwascopud.smarthub.coop/ui/]","defaultLanguageDisplayName":"English (United States)","isUsingLanguageSupport":false,"translations":{}},"canViewCreateRequestForm":true,"isProjectSimplified":false,"mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI1YTU0M2I1Zi04NDM5LTRiYjEtOTJkYy03NzZmMDc4YjJiZTQiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTp1cGxvYWQ6KiI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y29sbGVjdGlvbjp1cGxvYWQtdXNlci1jb2xsZWN0aW9uLTQxNDUxMDE3MSI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y2h1bms6KiI6WyJyZWFkIiwiY3JlYXRlIl19LCJleHAiOjE3ODQzNTYwNTYsIm5iZiI6MTc4NDM1NDg1NiwiYW5vbklkIjoiYW5vbi11c2VyIiwiaHR0cHM6Ly9pZC5hdGxhc3NpYW4uY29tL2FwcEFjY3JlZGl0ZWQiOmZhbHNlfQ.PAOFpHbGJh6YWWma6FrMslpuUkPYZHtpeqWuEKSj5wc","targetCollection":"upload-user-collection-414510171","endpointUrl":"https://api.media.atlassian.com","clientId":"5a543b5f-8439-4bb1-92dc-776f078b2be4","tokenDurationInMins":20}},"reqCreate":{"id":4,"projectId":10000,"issueType":{"id":"10002","name":"Request quote support"},"form":{"name":"Request a Quote","descriptionHtml":"<p>Use this form to request a new connection from Q-Life.</p>","callToAction":"Request a Quote","intro":"<p>Submit a request for a quote for a new service location using this form.</p>","instructions":"<p>Use this form to request a new connection from Q-Life.</p>","icon":10536,"iconUrl":"https://q-life.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10536","key":""},"fields":[{"fieldType":"text","fieldId":"email","fieldConfigId":"","label":"Email confirmation to","description":"","descriptionHtml":"","required":true,"displayed":true,"presetValues":[]},{"fieldType":"text","jiraFieldType":"com.atlassian.jira.plugin.system.customfieldtypes:textfield","fieldId":"customfield_10093","fieldConfigId":"10228","label":"Company or Organization","description":"What company or organization is this request for?","descriptionHtml":"<p>What company or organization is this request for?</p>","required":false,"displayed":true,"presetValues":[]},{"fieldType":"text","jiraFieldType":"summary","fieldId":"summary","fieldConfigId":"","label":"Location Address","description":"Insert the address of the location you wish to quote","descriptionHtml":"<p>Insert the address of the location you wish to quote</p>","required":true,"displayed":true,"presetValues":[]},{"fieldType":"text","jiraFieldType":"com.atlassian.jira.plugin.system.customfieldtypes:textfield","fieldId":"customfield_10056","fieldConfigId":"10158","label":"What is this location's common name? Ex. Adventist Health or Ace Hardware","description":"Enter the name of the end customer business or other identifiable information","descriptionHtml":"<p>Enter the name of the end customer business or other identifiable information</p>","required":true,"displayed":true,"presetValues":[]},{"fieldType":"checkbox","jiraFieldType":"com.atlassian.jira.plugin.system.customfieldtypes:multicheckboxes","fieldId":"customfield_10057","fieldConfigId":"10159","label":"How long of an agreement do you want for this connection?","description":"","descriptionHtml":"","required":true,"displayed":true,"presetValues":[],"values":[{"value":"10025","label":"Month to Month","selected":false,"children":[]},{"value":"10026","label":"12 Months","selected":false,"children":[]},{"value":"10027","label":"24 Months","selected":false,"children":[]},{"value":"10028","label":"36 Months","selected":false,"children":[]},{"value":"10029","label":"60 Months","selected":false,"children":[]},{"value":"10030","label":"Other (Explain in Description Field)","selected":false,"children":[]}]},{"fieldType":"textarea","jiraFieldType":"description","fieldId":"description","fieldConfigId":"","label":"Provide an overview of your request and include any relevant detail we might need to help you best. ","description":"","descriptionHtml":"","required":true,"displayed":true,"presetValues":[],"rendererType":"atlassian-wiki-renderer"},{"fieldType":"attachment","jiraFieldType":"attachment","fieldId":"attachment","fieldConfigId":"","label":"Attach any relevant files","description":"","descriptionHtml":"","required":false,"displayed":true,"presetValues":[]}],"userOrganisations":[],"canBrowseUsers":false,"requestCreateBaseUrl":"/servicedesk/customer/portal/1/create/4","requestValidateBaseUrl":"/servicedesk/customer/portal/1/validate/4","calendarParams":{"firstDay":0,"date":"2026-07-17T23:07:37-0700","useISO8601WeekNumbers":false,"dateIfFormat":"%e/%b/%y","dateTimeIfFormat":"%e/%b/%y %I:%M %p","timeFormat":"12"},"kbs":{"kbEnabled":false,"serviceDeskId":-1},"canRaiseOnBehalf":false,"canSignupCustomers":false,"canCreateAttachments":true,"attachmentRequiredField":false,"hasGroups":true,"canSubmitWithEmailAddress":true,"showRecaptcha":true,"siteKey":"6LePXLkdAAAAAF4gCNalrL1IvZcqbNbZf_Zakudd","mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI1YTU0M2I1Zi04NDM5LTRiYjEtOTJkYy03NzZmMDc4YjJiZTQiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTp1cGxvYWQ6KiI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y29sbGVjdGlvbjp1cGxvYWQtdXNlci1jb2xsZWN0aW9uLTQxNDUxMDE3MSI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y2h1bms6KiI6WyJyZWFkIiwiY3JlYXRlIl19LCJleHAiOjE3ODQzNTYwNTcsIm5iZiI6MTc4NDM1NDg1NywiYW5vbklkIjoiYW5vbi11c2VyIiwiaHR0cHM6Ly9pZC5hdGxhc3NpYW4uY29tL2FwcEFjY3JlZGl0ZWQiOmZhbHNlfQ.CL1vECj4X0uIRGxRhyaROVzoc8d3gonurOxiIN_2R14","targetCollection":"upload-user-collection-414510171","endpointUrl":"https://api.media.atlassian.com","clientId":"5a543b5f-8439-4bb1-92dc-776f078b2be4","tokenDurationInMins":20},"hasProformaForm":false,"proformaTemplateForm":{},"proforma":{"formExists":false,"formValid":false},"key":""},"portalWebFragments":{"headerPanels":[],"subheaderPanels":[],"footerPanels":[],"pagePanels":{"propertyPanels":[],"legacyPropertyPanels":[]}}}