Request Form
Back
Begin
Request Ticket Number
Company
*
Name of Requester
*
First Name
Last Name
Name of Approver
*
First Name
Last Name
Back
Next
Date Requested By
*
-
Month
-
Day
Year
Date
What would you like to request
*
New User
Replace Computer for Existing User
Back
Next
User Information
Name
*
First Name
Last Name
Company Phone
Please enter a valid phone number.
Extension
Please enter a valid phone number.
Cell
Please enter a valid phone number.
Job Title
Site
Department
Desk Location
Type of work
Current/Personal Email
example@example.com
Requested Email Address
example@example.com
Active Directory Username
Back
Next
User Computer Information
Will you be using an existing computer in inventory?
Yes
No
Existing Computer Name
Please list the model number, serial number, previous user, and list any other existing hardware.
Type of Computer
*
Please Select
Desktop
All-In-One
Laptop
Tablet
Brand
*
HP
Apple
Acer
Other
Computer Requested Brand
*
Operating System
Windows
Linux
ChromeOS
Number of required USB Ports (How many peripherals are you going to have connected?)
*
Requested Model
Advanced Configuration Options
TPM Enabled
Back
Next
Additional Desktop Options
Desktop Options
*
Mid-Tower
Mini-Tower
Micro
Additional Desktop Options
Ten Key
Fingerprint Reader
HDMI Port
Ethernet Port
CD/DVD Drive
Back
Next
Additional Laptop Options
Laptop Screen Size
14
15
17
Additional Laptop Options
Touchscreen
Ten Key
Fingerprint Reader
HDMI Port
Ethernet Port
CD/DVD Drive
Back
Next
Additional Peripherals
Additional Peripherals
Docking Station
USB Ten Key
USB Fingerprint Reader
USB Hub
External Harddrive
External CD/DVD Drive
Portal Printer
Portal Scanner
External Hard Drive TBs
*
Back
Next
Monitors
Number of Monitors
Back
Next
Monitor Details
Monitor Brand
*
HP
Apple
Acer
Other
Monitor Requested Brand
*
Monitor Size
24
27
32
Other
Specific Monitor Size
Monitor Additional Options
Curved
High Res
Monitor Stand
Back
Next
Monitor Cabling Configuration
Monitor 1 Connection
HDMI > HDMI
DP > HDMI
DP > DP
VGA > VGA
VGA > Display Port
VGA > HDMI
Monitor 2 Connection
HDMI > HDMI
DP > HDMI
DP > DP
VGA > VGA
VGA > Display Port
VGA > HDMI
Monitor 3 Connection
HDMI > HDMI
DP > HDMI
DP > DP
VGA > VGA
VGA > Display Port
VGA > HDMI
Monitor 4 Connection
HDMI > HDMI
DP > HDMI
DP > DP
VGA > VGA
VGA > Display Port
VGA > HDMI
Monitor 5 Connection
HDMI > HDMI
DP > HDMI
DP > DP
VGA > VGA
VGA > Display Port
VGA > HDMI
Back
Next
Standard Software Information
Choose Software to Install
*
RMM
SentinelOne
DUO
Proofpoint
Office
3cx
Teams
Google Chrome
CyberQP
Will the user require a DUO FOB or will they be using the DUO mobile app?
FOB
APP
Other Software
Back
Next
Customer Specific Software
Please upload the completed customer specific software requirements form.
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Private Printer/Scanner
Do you require a private printer at your desk?
Yes
No
Do you already of a private printer??
Yes
No
Do you require a private scanner at your desk?
Yes
No
Do you already of a scanner scanner??
Yes
No
Printer Type
Ink Jet
Laser
Printer Color
B/W
Color
Printer Paper Size
Letter - 8.5x11
Legal - 8.5x14
Tabloid - 11x17
Digital Sizes - 12x18,13x19,14x20,other
Scanner Paper Size
Letter - 8.5x11
Legal - 8.5x14
Tabloid - 11x17
Digital Sizes - 12x18,13x19,14x20,other
Back
Next
Network Printers/Scanners
Please list the network printers that you will need access to.
Please list the network scanners that you will need access to.
Technicians: Please remember to configure the user in the "copystation" for printing and scanning if necessary.
Back
Next
Email/Office 365 Configuration
Required License
Company Standard
Please list the group calendars that you will need access to.
Please list the mailing lists that you need to be associated to.
Back
Next
Phone System Configuration
Internal Phone System
3cx
Other
None
Requested Extension Number
3cx Desktop Application Needed
Yes
No
3cx Phone App Needed
Yes
No
Additional Phone System Configuration/Notes
Submit
Should be Empty: