I.T. Request Form

2. Village of Germantown I.T. Assistance Request Form
   Please fill out all applicable categories. NOTE: This form is intended for Village of Germantown Employees.

   Please fill out all applicable categories. NOTE: This form is intended for Village of Germantown Employees.

4. Name

5. Phone Number

7. Building / Location

   1. Department of Public Works
   2. Fire Station 1
   3. Fire Station 2
   4. Police Department
   5. Senior Center
   6. Village Hall

8. Concern is Regarding

   1. Computer Hardware
   2. Computer Software
   3. Printer
   4. Email
   5. Phone
   6. Networking / Server Access
   7. Other

9. Priority Level

   1. 1 - Address as time allows
   2. 2 - Within 2 Weeks
   3. 3 - Within 1 Week
   4. 4 - Within 1 or 2 Days
   5. 5 - Immediate

11. Specifics

    Please specify the details of your concern including the frequency of the issue and any errors you are receiving.

15. FOR I.T. STAFF ONLY

17. Completed By

18. Date Completed

19. Time Required to Complete

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field