Managed Print Services
MPS Equipment Ordering Form

Please use this form to order new or replacement equipment (Copiers, printers, faxes, scanners, and Multi-Function Products (MFP)).

(Items marked with an asterisk are required.)


* Name: (You must type in a response)
 
 
* Department: (You must type in a response)
 
 
* Department ID Number: (You must type in a response)
  Please enter your Department ID Number.
 
 
* Department Account Number: (You must type in a response)
  Please enter your department's account number
 
 
* Email: (You must type in a response)
 
 
* Phone: (You must type in a response)
 
 
* Address: (You must type in a response)
 
 
Type of Request: (Select only one)
 
New Order /New Location
Additional order / Existing Location
Replacement Order
Service Loaner
 
If Replacement - type in Serial Number (Type in a response)
 
 
If Service Loaner Request, please provide brief explanation. (Type in a response)
 
 
* Number of Users (You must type in a response)
 
 
* Services Needed: (You must select at least one)
 
Print
Copy
Black and White
Color
Scan
Fax
 
Estimated Black and White pages/month (Type in a response)
 
 
Estimated Color pages/month (Type in a response)
 
 
* Explanation of need and usage requirements, other info, etc. (You must type in a response)