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Technology Purchase Request Form
for PC based computers

Name: (Please supply both first and last name)
Email Address
On Campus Phone #
College of:	Select Business Arts & Sciences Education & Health Sciences Professional Studies
Department:
Purchase Type:	Select New Replacement
Who the equipment is going to if different than above (Please supply both first and last name):
*new = does not currently have a computer, replacement = currently has computer

*Select only one item from the following two drop down boxes
Laptops	Desktops
Select Latitude D630 Latitude D630 with Dock Latitude D830 Latitude D830 with Dock	Select Optiplex 745 w/ 17" Flat Panel
PCs will have the following software installed by the IT Department: Windows XP Professional Internet Explorer Microsoft Office Professional Suite Adobe Reader

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518 West Locust Street, Davenport, IA 52803 563/333-6000 or 800/383-2627 Published by: Information Technology, Copyright, All rights reserved.