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2. Please Read

   Cell Enabled iPads, City-issued cell phones, and Hot Spot requests should go to Central Purchasing. 

   All equipment requests have a 5-day lead time. Items that need to be ordered will take longer than 5 days.

4. Requestor Name*
5. Requestor Title*
6. Requested For*
8. Department Name*
9. Work Number*
10. Cell Number

14. Monitors larger than 22" are funded by your department. We will request a quote upon receipt of your request and send it via email for approval. 

16. Type of Request*
    -- Select One --TemporaryPermanent
17. Type of Equipment*
    -- Select One --LaptopMonitorDesktop ScannerProjection ScreenIpad (Wi-Fi Only)Other
18. Other Equipment*
19. Monitor Size
    -- Select One --22"24"27"
21. Would you like to request more equipment?
    -- Select One --YesNo
22. Type of Request
    -- Select One --TemporaryPermanent
24. Type of Equipment
    -- Select One --LaptopMonitorScannerProjection ScreenIpad (Wi-Fi Only)Other
25. Other Equipment*
26. Monitor Size
    -- Select One --22"24"27"
28. Justification for Equipment Request*
32. Requested Pick-Up Time
    Requested Pick-Up Time

    The date you request is not guaranteed. There is a 5-day for all equipment requests. 

33. Return Date
    Return Date
37. Authorizing Supervisor's Name*
38. Authorizing Supervisor's Email*
40. Signature Confirmation

    I accept full responsibility and liability for this equipment while under my care. I will return this equipment to the City of Annapolis, Office of Integrated Technology Services on or before the date entered above or upon termination of employment.

42. Type Signature

    By typing your name above you are confirming you understand the terms and conditions stated above in the signature confirmation.

Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field