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IT Service Request Form
Requested By:
Please enter your name.
Reply To E-mail Address:
Please enter your e-mail address for contact purposes.
Please enter your Telephone Number or Extension.
Please select the name of the Building or Location.
Room Number:
Please enter the room number or floor only.
Please select a Priority level for your Service Resuest.
Priority Response Time           Resolution Time
Priority 1           Urgent 2 Hours 4 hours
Priority 2 High 1 Day 1 Day
Priority 3 Low 1 Day 1 Or More Days
Priority 4 Project Request           1 Day 5 Or More Days
*Note: Priority 1 requests are to be reserved for emergencies
Service Requested:
Please describe the nature of the service requested in the briefest manner possible.