Q1. Are you Moving or Relocating?
a. I'm moving/relocating on campus.
b. I'm moving/relocating off campus.
c. I'm leaving the University.
d. I'm requesting to move an office or lab.
e. The move involves hazardous or radioactive materials.
f. There are items with asset tags.
g. Items include a computer.
Q2. Are you Disposing of Furniture, Equipment, Bio-Hazardous or Radioactive Materials?
a. The item has an asset tag.
b. The item is or has been exposed to materials that are bio-hazardous or radioactive.
Q3. Are you requesting an EHS inspection?
a. The lab equipment has been exposed to bio-hazardous materials.
b. The lab equipment has been exposed to radioactive materials.
Q4. Do you have a work request for any of the services below?

a. Electrical
b. Carpentry
c. Plumbing
d. Port Installation/Removal
e. PC Reconfiguration
f. Telephone

Q5. Are you making a Purchase?
a. It's a new purchase.
b. It's a replacement.
c. It involves hazardous or radioactive materials.

Please complete the contact information below and all relevant fields. Asterisks (*) indicate required fields:

Name *
Phone * ( ) -
Email *
Fax ( ) -
Acct No. 00000
Department
Building / Room
Move Date (if moving) Month Day Year
Request Completion Date Month Day Year
Special Instructions
Do you require a cost estimate? Yes
Is your request urgent (required within a 48 hour time period)? Yes