Company Name
*
Name
*
First Name
Last Name
Email
*
What type of PC is required?
Will This PC replace an existing PC?
*
Who will be the primary user?
*
Will encryption be needed to protect sensitive data to comply with PCI DSS, HIPPA or other requirements?
Do you need monitors?
If No, please provide make and model of your current model.
What size monitor do you need?
If you need a monitor larger than 32", what size do you need?
Memory (RAM)
Specify RAM requirements.
Will you need Productivity Software? Check all that apply.
Other Productivity Software
How Many Licenses?
License Information (Product Key, Serial Number)
Software Login Information
Software Support Information
Installation Media (Download, Disk, Online)
Hard Drive Size
Do you need a battery backup/ surge protection?
Printer/Scanner Setup- Select all that apply
If you have a printer or scanner, provide the make and model number.
Do you have an existing data back up?
If yes, provide details.
Additional Requirements/Requests
