Please fill in ALL applicable sections.

Computer Information Section
(How to find this information:)   For a PC click here    For a MAC click here
SYSTEM NAME   (e.g. : DFPM-ADM-JFR)
SYSTEM MANUFACTURER   (e.g. : HP, Dell, Apple)
SYSTEM MODEL   (e.g. : iMac, MacBook Pro, HP Z400 Workstation)

Personal Information Section
YOUR UNID   (e.g. : u0123456)
YOUR NAME Last:

First:
YOUR CONTACT PHONE #
YOUR EMAIL ADDRESS

Other people who will use this computer:

PERSON #2 UNID  
PERSON #2 NAME Last:

First:
PERSON #3 UNID  
PERSON #3 NAME Last:

First:
PERSON #4 UNID  
PERSON #4 NAME Last:

First:

 If you have more than 4 people using this computer, PLEASE check this box, and we will contact you for the information.
rev. 07-20-2010