UTFI iPad Request Form

iPad & Card Reader Equipment Request Form

To request an iPad and card reader for non-philanthropic and registration transactions for an upcoming event, complete and submit this form. Please request equipment at least 4 days prior to the event to allow for setup and training. Call (865) 974-4153 if you have any questions. Your request is not complete until you receive an email confirmation.
Sender Name
Sender Email
example@example.com
Department Representative Name*

First NameLast Name
Department Name*
Department Representative Email*
Department Representative Phone Number
(Area Code) 555-0000
What Software Will you be Using? (Select one or both)*

Converge Mobile (processing payments)The Check-In App (tracking event attendance)
For What Purpose or at What Event will the Equipment be Used?*
Number of iPads Requested*
The office has 6 iPads
Number of Card Readers Requested
The office has 6 Card Readers
Names & Net IDs of All Individuals that will be Using the Equipment*
Net IDs are REQUIRED for any individuals that will be using the equipment. The number of names/net IDs should match the number of iPads/card readers requested.
Date(s) of Event
If iPads and/or card readers will be used over multiple days, enter dates or date ranges
Desired Pick-up Date

MonthDayYear
Date you wish to pick up iPads and/or card readers prior to event
Address that should be Listed on Customers' Order Confirmation (if Using Card Reader Only)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
A hot spot is required to process credit card transactions. To request a WiFi Hot Spot, contact UT Cellular Services at (865) 974-9091 or celladm@utk.edu.
Equipment will be Used to Process Credit Card Transactions

Yes, and I have requested a WiFi Hot SpotYes, but I have not yet requested a WiFi Hot SpotNo
If the equipment is damaged or broken, the College/Department responsible for/using the equipment will be responsible for replacing the damaged equipment. By signing below, you are agreeing to these terms.
Department Representative Signature*

Clear
Should be Empty:

iPad & Card Reader Equipment Request Form