IT Equiptment Request | COVID-19 SCREENING

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YOUR SOURCE FOR COVID-19

REGISTRATION, SCREENING, AND TESTING.

UMMC COVID TESTING SITE IT EQUIPTMENT REQUEST FORM

Please fill out the all the fields. Allow 24 hours to process your request

Requested By:

Company

Address

Testing Start Date

Testing End Date

Start Time

End Time

Network Type

Wired

Wi-Fi

No. of Computers Required

Site IT Contact:

Name

Phone

Email

Is the contact on site or offsite?

Site Contact for UMMC:

Name

Phone

Thanks for submitting!

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