Equipment Request Form

*All fields are required.

Today's Date
Customer's Name
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?
(How will the equipment in question be used?)
Additional Comments

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