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HSC - ITS - Standard Equipment Request Form
Contact Information
Email ITPurchaseRequest@hsc.wvu.edu for any special requests.
Name
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First
Last
Phone Number
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Email
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Department
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Billing/EBO Information
Name
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First
Last
Phone Number
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Email
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Department
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Equipment Options
Desktops (Check All That Apply)
Small Form Factor – 16GB RAM, 512GB SSD, 3 Year Warranty
Mini Tower – 16GB RAM, 512GB SSD, 3 Year Warranty
Please Note:
(Prices may vary, a quote will be assigned to you via the WVU MarketPlace)
Entry Level Quantity
*
Power Level Quantity
*
DVI-I Cable: Dell part number H679K Quantity
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Laptops (Check All That Apply)
Dell Latitude 7420 – 14” Display, 16GB RAM, 256GB SSD, 3 Year Warranty
Dell Latitude 7420 2-in-1 – 14” Display, 16GB RAM, 256GB SSD, 3 Year Warranty
Apple MacBook Air – 13” Display, 8GB RAM, 256GB SSD, 3 Year Warranty
Apple MacBook Pro – 13” Display, 16GB RAM, 256GB SSD, 3 Year Warranty
Please Note:
(Prices may vary, a quote will be assigned to you via the WVU MarketPlace)
Dell Latitude 7420 (14") Quantity
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Dell Latitude 7420 2-in-1 (14") Quantity
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Apple MacBook Air (13") Quantity
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Apple MacBook Pro (13") Quantity
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Tablets (Check All That Apply)
Microsoft Surface Pro – 12.3 inch Display, 8GB RAM, 256GB SSD, 2 Year Warranty
Apple iPad –10.2 inch Display, 128GB HDD, 2 Year Warranty
Apple iPad Pro – 11 inch Display, 128GB HDD, 2 Year Warranty
Please Note:
(Prices may vary, a quote will be assigned to you via the WVU MarketPlace)
Microsoft Surface Pro (12.3") Quantity
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Apple iPad (10.2") Quantity
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Apple iPad Pro (11") Quantity
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Monitors
Dell U2419H – 24” Display, (DP/HDMI), 1920x1080
Please Note:
(Prices may vary, a quote will be assigned to you via the WVU MarketPlace)
Dell U2419H (24") Quantity
*
Printers (Check All That Apply)
Bizhub 4700P (Monochrome Black Ink Only Printer)
Bizhub C3100P (Color Single Function Printer)
Bizhub C3110 (Color All-In-One Printer)
Bizhub C364e (Color Multifunction Printer)
Bizhub 364e (Monochrome Black ink only - Multifuction Printer)
Please Note:
(Prices may vary, a quote will be assigned to you via the WVU MarketPlace)
Bizhub 4700P (Monochrome) Quantity
*
Bizhub C3100P (Color) Quantity
*
Bizhub C3110 (Color) Quantity
*
Bizhub C364e (Color) Quantity
*
Bizhub 364e (Monochrome) Quantity
*
User Information
Recipient’s Name
*
Recipient’s Department
Recipient’s Phone Number
*
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Recipient’s Email
Recipient’s Room #
*
Specialized Software Requirements (if applicable)
Additional Comments
Limited Exceptions
Hardware and/or software orders not matching HSC ITS standards or purchases made outside of the WVU Mountaineer MarketPlace and/or SLIC must be pre-approved prior to ordering equipment/software. Pre-approval requests should be made at
http://wvu.qualtrics.com/jfe/form/SV_3xvJ0fsDJJF9sup
Upon completion of each Professional Development/CME funded order placed through Mountaineer MarketPlace, it is the responsibility of the Department to report the device value, date of purchase, employee’s name and employee number to WVU Tax Services. Devices purchased for personal use are taxable and must be included as a taxable fringe benefit in the employee’s wages. Please email WVU Tax Services with the above information at:
tax@mail.wvu.edu
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