*Fields in bold text are required.
Contact Name*
Company Name*
Department / Location / Site*
Email Address
Telephone Number
User’s Name (if request has not come from the equipment user)
User’s Job Desciption
Date equipment is required by
Equipment Type e.g. Windows Laptop, Windows Desktop, MacBook, iMac, iPad, Windows Tablet, Android Tablet, Printer, Monitor*
Laptop – Screen Size e.g. 13”, 14”, 15”, 17” (if applicable)
PC – Monitor Size e.g. 21”,24”, 28” (if applicable)
Any specialist Printer functions (if applicable)
Any other specific or non-standard requirements e.g. weight, convertible model, Touchscreen, DVD (if applicable)
Any additional software requirements e.g. Adobe, Auto Cad (if applicable)
Accessories required e.g. Additional Monitor – Monitor Size e.g. 21”,24”, 28” (if applicable), Monitor Arm, Docking Station, External Keyboard & Mouse, Case
New Requirement or Replacement*
Username or AAG ID of existing equipment if it is a replacement
Do they require an on-site Installation*
On-site Contact for Delivery / Installation
Person that will authorise*
Security:* (Write the figure 12 as a word in lowercase)
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