Equipment Request Form

*All fields are required.

Today's Date
Customer's Name
Department
Phone Number
Equipment Type
Equipment Specifications
Account Number

*Enter the first 13 digits of the account number and then select
the final five digits from the drop-down list.

*It is your department's responsibility to ensure that your funds
are in the proper account.
Is a Warranty Available?
Need By Date
Customer's Employee Position Code
(For IT Inventory Purposes)
New or Replacement Equipment?
Is this item replacing a printer?
If so, what is being replaced?
How many printers are in your department/area?
Number of Items
Building #
Room #
What furniture, data ports, electrical outlets, and telephone ports do you have available to you prior to this move?
Justification
(How will the equipment in question be used?)
Additional Comments
(Optional)
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