New Order Request

Company*

User First Name*

User Last Name*

Address

Street Address City State ZIP

Start Date

Email*

Personal Email

Telephone Number/Ext:*

Mobile Phone Number

Department

Title*

Will a NEW computer be needed or will an EXISTING computer be used?*

If a NEW computer, would you like us to give you a quote?*

What brand would like to purchase?*

What type of computer would you like to purchase?*

What performance and storage level of the computer is your preference?*

Additional specifications for your new computer (optional):

CPU:

Memory:

Storage:

Screen Size:

Keyboard:

Mouse:

Other:

If EXISTING computer, what is the computer name, serial number or service tag number?*

IF EXISTING computer is this a shared computer?*

Printers to install

Programs to install

Will user need remote access to this computer?

Any specific credentials needed (i.e. QuickBooks, MS Office, etc.)

Additional comments

Submitter's Name*

Submitters' Email*

Name

This field is for validation purposes and should be left unchanged.