IT Equipment Request Form


This form must be used for all IT equipment requests

Site Name:
  
Requestor Name:    
Requestor Email:    
Authoriser Name:    
Authoriser Email:    
Authoriser Position:    
Clinic/Department:    
Date of Order: 15-Oct-2019  
Requested Delivery Date:   ***We will attempt to meet the requested delivery wherever possible***
Cost Code:    
For AMS's outside of KAMSC please attach a copy of your purchase order
Purchase Order (PDF only):***Please upload PDF file only (size of file to be <1Mb)
Quantity Hardware
(e.g. Desktop/Laptop/Phone)		 Details End User

Copyright ©2010 Kimberley Aboriginal Medical Services Council Inc. All Rights Reserved. • LEGAL DISCLAIMER / COPYRIGHT
PO Box 1377 - Broome - Western Australia 6725 • Phone: (08) 9194 3200 - Fax: (08) 9192 2500 Email: kamsc@kamsc.org.au