PRINTER & SPECIFICATIONS REQUEST FORM DATE PSRF NUMBER REQUESTOR PROJECT AREA TYPE OF REQUEST COST CENTER/WBS EMAIL ADDRESS RECEIVED DATE MOBILE NUMBER RECEIVED BY (OMD) RENEWAL REQUEST NO. SUPPLIER NAME PRINTER BRAND PRINTER MODEL BODY SERIAL NUMBER MONTHS EXTENSION LOCATION CONTACT PERSON CONTACT NUMBER REMARKS 1 2 3 4 5 6 NEW REQUEST ESTIMATED SPECIFICATIONS NO. PRINTED PAGES MAX PRINT SIZE MAX SCAN SIZE NETWORK EQUIPMENT PRINTER TYPE COPY OPTION DEPARTMENT REMARKS 1 2 3 4 5 6 ADDITIONAL NOTES/INSTRUCTIONS REMARKS DELIVERY DETAILS DELIVERY ADDRESS: CONTACT PERSON: CONTACT NUMBER: PREPARED BY: ADMIN IN-CHARGE PROJECT DIRECTOR Signature Over Printed Name/Date Signature Over Printed Name/Date NOTED BY: PROJECT MANAGER REQUESTING DEPT DIRECTOR Signature Over Printed Name/Date Signature Over Printed Name/Date APPROVED BY: PROJECT PLATFORM MANAGER OMD DIRECTOR Signature Over Printed Name/Date Signature Over Printed Name/Date