Request Form

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City of SelmaInformationTechnology(IT) Department Assistance/IssuesComputerReportingForm
Modified: 9/07/2012 To report any IT issues, please complete the appropriate portion of this form. The end-user or his/her Department Head may complete this form. Once the form is completed, it must be initialed by the Department Head, before forwarding to the IT Department. To: IT Dept. City of Selma Phone: (334) 874-2575 Fax: (334) 874-3954 e-mail: [email protected]) Date of Request:       User's Name:       Department:       Type of Computer:      
Is this an emergency that requires immediate attention? Yes If no, what times are you available?      

Dept. Head Initials: Phone:       Office Number:      

Natureof Problem( and or error message):      

Has this been a recurrent problem? Yes No Don't know When did the device last function properly?       Is the System under warranty?       Don’t know Requestfor installationof softwareor upgradeof components(e.g., memory). Please note that funding for purchase of software or upgrades for your computer must come from your department. 1. 2. 3. Date: Received:      Technician'scomments/recommendations:       Contact Person:

Date of repair:      

Tech. Initials:      

It Dept. Head Initials:     

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