2. Name of Person Submitting Request*
3. Phone*
5. Which of the following apply?*

   1. New Asset (value > $1000)
   2. Transfer Asset
   3. Equipment Donation

   1. Equipment Addition
   2. Equipment Move
   3. Equipment Remove
7. Asset Description*
8. Date*
   Date
10. Department*
11. PO# (if applicable)
13. Equipment Location:
15. Building*
16. Floor
17. Responsible Employee
19. Any additional equipment location notes
21. Phone
22. County Cell Phone
24. Please provide County ID# for:
26. CPU/Laptop
27. Printer
28. Monitor
29. Other
31. Describe other equipment
33. Additional Notes or Instructions
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field