Request for Equipment Procurement

*All fields are required.

Today's Date:

Requestor's Name and Title:

Department:

Phone Number:

This is a request to order the following equipment.

1. Type of equipment to be ordered:

2. Equipment specifications:

3. Date equipment is required:

4. Quantity required:

5. Location (building and room number):

6. Employee's position code (for IT inventory purposes):

7. New equipment or replacement equipment::

8. Account number to charge for equipment:

9. Availability of furniture, data ports, electrical outlets, and telphone ports prior to move:

10. Additional Comments

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Today's Date:

Requestor's Name and Title:
Department:
Phone Number:

This is a request to order the following equipment.
1. Type of equipment to be ordered:
2. Equipment specifications:
3. Date equipment is required:
4. Quantity required:
5. Location (building and room number):
6. Employee's position code (for IT inventory purposes):
7. New equipment or replacement equipment::
8. Account number to charge for equipment:
9. Availability of furniture, data ports, electrical outlets, and telphone ports prior to move:
10. Additional Comments