5
Equipment Services - Audiovisual Order Form
If you have questions, please call
621-3852
Course Information, please use one form per period.
User:
Department/Organization:
Course:
Phone Number:
Email:
Billing Information
(Non-course users only!)
Organization:
Email:
Phone:
Billing Address:
P.O. Box:
State:
Select state
Alabama
Arizona
Arkansas
Alaska
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Select Audiovisual Support Equipment:
Equipment
Quantity
Options
Videocassette Recorder (VCR) W/Monitor (TV):
0
1
2
3
4
5
6
7
8
9
Select Size
1/2" - Standard
3/4" - Oversized
Video Projection Unit (
Laptop supplied by instructor
):
0
1
2
3
4
5
6
7
8
9
VPU Detail
PC Laptop
Mac Laptop
VCR
Overhead Projector:
0
1
2
3
4
5
6
7
8
9
Carousel Slide Projector:
0
1
2
3
4
5
6
7
8
9
Wireless Remote for Slide Projector:
0
1
2
3
4
5
6
7
8
9
16mm Film Projector:
0
1
2
3
4
5
6
7
8
9
Audio Cassette Recorder/Player:
0
1
2
3
4
5
6
7
8
9
Laptop Computer Cart (
ILC only
):
0
1
2
3
4
5
6
7
8
9
Other (Please Specify):
Reservation Information ( Location and Time )
Building
Room Number
Location:
Semester
Select term
Fall
Spring
Pre-session
Summer Session I
Summer Session II
Select year
2006
2007
2008
2009
2010
2011
2012
Start Time
End Time
Requested Time:
Select hour
1
2
3
4
5
6
7
8
9
10
11
12
Select minutes
00
05
10
15
20
25
30
35
40
45
50
55
AM
PM
Select hour
1
2
3
4
5
6
7
8
9
10
11
12
Select minutes
00
05
10
15
20
25
30
35
40
45
50
55
AM
PM
*Other Times:
*
Should there be different times on different days, fill this out. Otherwise leave blank.
Please be as specific as possible.
Monday
Tuesday
Wednesday
Thursday
Friday
Required Day[s]:
Month
Date
Select month
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Select month
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Select month
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Select month
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Select month
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Do you want an email copy of this order?
Yes
No
If you have questions, please call
621-3852
© 2006 - Arizona Board of Regents. All rights reserved.