IT Equipment Request – Coastal Medical

IT Equipment Request Form

Name *

First

Last

Manager's of (optional)

Manager's Name *

First

Last

Job Title *

Description of Equipment Requested *

Purpose of Request *

Why do you need this equipment? (Please select all that apply and provide details below)

Please Provide Further Explanation *

Make / Model (optional)

Link to Product Page or Spec Sheet (optional)

Justification for Particular Model (optional)

Note: Final selection and purchasing will be managed by the IT team to ensure compatibility, warranty, and supportability.

Accessories (optional)

Does this equipment require any additional accessories or software? For example, a laptop may also require a docking station, keyboard and mouse.