Ticket Number (Internal Use): Last Updated: 1/14/16 IT HARDWARE REQUEST FORM SC MOBILE PHONE: *Do you have a need to be reachable after business hours? YES NO *Do you work off-site on a regular basis (e.g. TRAVEL, TELEWORK, ETC.)? YES NO *Required Field NEW ISSUE - PERMANENT INTERNATIONAL LOANER DOMESTIC LOANER LOANER EXTENSION UPGRADE DEVICE UPGRADE SERVICE REPLACEMENT (of permanently assigned device) Loaners - specify dates needed: Extensions - specify end date: LAPTOP: PERMANENT *% travel time: LOANER *Dates Needed: DOMESTIC INTERNATIONAL AIRCARD: PERMANENT *% travel time: LOANER *Dates Needed: DOMESTIC INTERNATIONAL PRINTER: COLOR TO SERVICE 5 OR MORE PEOPLE BLACK & WHITE MONITOR: 22” OTHER (Specify): OTHER HARDWARE: RSA Token REQUESTOR’S NAME: DATE OF REQUEST: ORGANIZATION: PHONE: SUPERVISOR’S NAME: PLEASE PROVIDE THE BUSINESS JUSTIFICATION FOR YOUR HARDWARE REQUEST: Approved Disapproved SUPERVISOR’S SIGNATURE DATE Approved Disapproved IT AUTHORIZER SIGNATURE DATE PLEASE RETURN FORM, SIGNED AND APPROVED BY SUPERVISOR, TO THE HELP DESK FOR PROCESSING
Transcript
Ticket Number (Internal Use):
Last Updated: 1/14/16
IT HARDWARE REQUEST FORM
SC MOBILE PHONE:
*Do you have a need to be reachable after business hours? YES NO
*Do you work off-site on a regular basis (e.g. TRAVEL, TELEWORK, ETC.)? YES NO *Required Field
NEW ISSUE - PERMANENT INTERNATIONAL LOANER DOMESTIC LOANER LOANER EXTENSION UPGRADE DEVICE UPGRADE SERVICE REPLACEMENT (of permanently
assigned device)
Loaners - specify dates needed:
Extensions - specify end date:
LAPTOP:
PERMANENT *% travel time: LOANER *Dates Needed:
DOMESTIC INTERNATIONAL
AIRCARD:
PERMANENT *% travel time: LOANER *Dates Needed:
DOMESTIC INTERNATIONAL
PRINTER: COLOR TO SERVICE 5 OR MORE PEOPLE BLACK & WHITE
MONITOR: 22” OTHER (Specify):
OTHER HARDWARE: RSA Token
REQUESTOR’S NAME:
DATE OF REQUEST: ORGANIZATION:
PHONE: SUPERVISOR’S NAME:
PLEASE PROVIDE THE BUSINESS JUSTIFICATION FOR YOUR HARDWARE REQUEST:
Approved Disapproved SUPERVISOR’S SIGNATURE DATE
Approved Disapproved IT AUTHORIZER SIGNATURE DATE
PLEASE RETURN FORM, SIGNED AND APPROVED BY SUPERVISOR, TO THE HELP DESK FOR PROCESSING