First name

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Last name

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Phone number

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(xxx)xxx-xxxx

Email address

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@cwu.edu

Department name

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Tag number

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Type of computer needed

Windows

Mac

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Desktop or laptop?

Desktop

Laptop

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Office or lab computer?

Office

Lab

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Current owner

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Building location

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Office or room number

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Justification for replacement

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Other funding sources

Please list other funding sources if purchase exceeds $1,000

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