New Equipment Request Form

2. First Name:*

3. Last Name:*

5. Department:*
   -- Select One --AdministrationAssessment CenterBuilding ServicesBusiness Office/FiscalCASA/CRBClerksCommunity DetentionCourt IntakeCourt ReportersDetentionInformation SystemsJudicial OfficesMaintenance/Custodial ServicesMediationProbationProsecutorPsychologyPublic DefendersPublic Information/ReceptionSecurityYouth Treatment Center (YTC)Other

6. Other Department:*

   Please type the name of your department.

7. Phone Number:*

9. Type of Device:*

   1. Hardware
   2. Software
   3. Accessories
   4. Other

10. Hardware:*

    1. Desktop Computer
    2. Laptop
    3. Monitor
    4. Network Printer
    5. Standalone Printer

11. Software:*

    1. Microsoft Office
    2. GroupWise
    3. Internet
    4. Adobe

12. Accessories:*

    1. Monitor
    2. Keyboard
    3. Mouse
    4. Network Cable
    5. Speakers

14. Other:*

    If equipment is not listed, please detail request in this field.

16. Date Needed By:*
    Date Needed By:

17. How Many:*

    Numerical answer only, please.

18. Reason for Need:*

20. Budget:*

21. Source of Budget:*

23. Other Comments/Relevant Information:

Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field