Printer Request Form

*Name:

*E-mail:

*Phone:

*Department:

*Account Number:

Contact Name:

Contact E-mail:

*Manufacturer:

*Model:

*Building Name:

*Room Number/Name:

Jack Number that printer will be plugged into:

Delivery Destination:
(if different than above)

*Will this printer be:

connected to a single computer (personal)
connected to the network (shared)

If connected to the network, please indicate:

Requested Printer Name:

12-chars. max., no spaces. Use only lowercase letters, digits, and dashes.

Number of computers sharing this printer:

*Does this printer replace an older one?

No Yes

If Yes and it was connected to the network, enter old printer information:

Printer Name:

Static IP Address (if known):