COMMUNITY MIDDLE SCHOOL
Request for printer cartridge(s) and mouse replacements.

While our budget for technology supplies has decreased, the cost of printer cartridges has continued to increase. I have been asked to track cartridge inventory and usage. I hope this simple form will be convenient for you to use, while providing me with the information needed to order supplies more accurately.

Once you submit your order, I will either put your mouse/cartridge/cartridges in your mailbox (if needed) or deliver them to your classroom to review the installation process with you.
Room number or location
First Name
Last Name
Date
DATE FORMAT REQUIRED: x/x/xx (example: 4/1/05)


Printer Manufacturer/Model
IMPORTANT - your request cannot be processed properly unless this information is accurate.
PRINTER CARTRIDGES/TONER - use the space above to idenityf the manufacter as follows:

HP Deskjet 720
HP Laserjet 1100
Lexmark Optra S1250
etc.
      Specify Color

N/A
Uncheck this box & make appropriate selection(s) for cartridge requests only.

 Inkjet - DeskJet) Color
Inkjet - DeskJet) Black
Laser - Black
Laser - Color - Magenta
Laser - Color - Yellow
Laser - Color - Black
Laser - Color - Cyan

Additional Comments/Requests

CDs, Diskettes, Mouse, Mousepad, etc.

DISKETTES
Type diskettes and the number needed in the space above.

CDs
Type CD and the number needed in the space above.

-OTHER EQUIPMENT-
Indicate your request in the space provided above. CD-Drive, Floppy Drive, Replacement Mouse, Mouse Pad, Flash Drive etc.


Your used cartridges will be used for recycling. Please drop them off in my mailbox or at my office (309) at your convenience.

When you hit the Submit Data button, the information from you form is emailed to me directly, as well as submitted and saved to an online data base.

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