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