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
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OITS FUNDING AUTHORIZATION SIGNATURE
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DATE
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Approved
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Disapproved
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