Equipment Delivery Request Form

This order form is only valid when a verification e-mail is returned to you from the IMC. All requests require 3 working days prior to the event. Use is limited to Missouri Western faculty and staff for Missouri Western classes and events only. All equipment will be setup/delivered during the setup/delivery time you indicate.

Your Information

Name:

Email:

Phone:

Today's Date and Time: 11/22/2008 1:04:58 PM

Delivery Information

Event or Class Name:

Date of Delivery:

Requested Setup/Delivery Time:

Actual Time of Event:

Building/Room to be Delivered to:

Date for the equipment to be retrieved:

Time for the equipment to be retrieved:

Presentation Equipment

	Quantity	Training Needed
Display Devices:
Data/Video Projector
TV/Data Monitor
Easel for flip chart pad
Dry Erase Easel
Display Easel-Tripod Easel
Screen
Slide Projector
Overhead Projector
Sources:
Desktop Computer
PC Laptop computer (for presentations)
Check accessories need for laptop above: CD/DVD Drive Zip Drive Internet Audio Wireless Mouse
I will bring my own laptop
My Laptop is a PC Macintosh Connections needed for your laptop: Audio Video Internet**
Audio Tape/CD Player
Boom Box - Audio Tape/CD
Document Camera
VCR Player
DVD Player
Camcorder/Tripod - MiniDV
Wired Microphone/Table Top Stand
Wired Microphone and Tall Stand
Wired Podium Microphone
Wireless Lapel Microphone
Wireless Handheld Microphone
Small AV Cart

Classroom Services DOES NOT provide consumables such as easel paper, dry erase pens, erasers, tapes, etc.

**If Internet connection is needed for a laptop that has not been used recently on Western's network you must contact IT to register the machine before it can access the network.

Please outline special instructions for presentation equipment set-up.

If training is needed, please indicate desired training time:

Indicate the number of technicians needed (if necessary):

If Technician(s) necessary, please indicate times needed:
to

Technician fees are $8.00 per hour/per technician for all activities not directly related to a Missouri Western Credit or non-credit class. Technicians must be requested 10 working days prior to the event.