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IP Request

(* Required)  
Request by *
Your E-mail Address *
Name of Person Using Device Being Registered *
Department *
Room Number
Select Action
Please Select Equipment Being Assigned * PC
  Macintosh
  Printer
  Other
Hardware Address (In Hex) (00-11-22-33-44-55)
Current Address (If Assigned)
Current Node Name (If Assigned)
State Asset # 742-xxxxx
IRD # (only if no State #) IRDxxxxx
Special Notes