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UNM Cancer Center Medical Informatics & Technology Support

Computer Request Form (Form to be used to purchase HSLIC/ Cancer Center Workstation / Laptop / Hardware / etc.)

Name:
User (purchased for):
Department:
System: Desktop Laptop Peripheral
Estimated total of purchase:
Is this an addition or replacement?
Additional Software Required:
Check Out: If planning to use at home, please explain the purpose for home use and reasons for check out (HIPAA).
Purchase Details: (include purpose/justification, specifications, quotes, etc.)
Date When Needed: