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iTech:Information Technology of the University of Southern Mississppi

Equipment Request Form

Last Name:
First Name:
Empl ID:
Email Address:
Telephone Number:
Department:
Office Building:
Office Number:
Date Needed:
Time Needed:
Pickup Date:
Pickup Time:


Please select the type(s) of equipment you need:
Video Player (1/2", VHS)
TV Monitor
Monitor Cart
Overhead Projector (HL)
Cart 36"
Video/Data Projector
Speaker System

Accessories:
Visual Presenter
Screen (60", 72", 13')
TV/VCR Combo (13")
Microphone
Extension Cord (AC)
Other (specify below)


Comments:



 
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