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Department Name
Equipment Location
OMNI Dept ID / Fund
OMNI Project Code
*
First Name
Last Name
Phone #
Type
Change Machine
Coin-op Machine
Color Laser Printer
Copier
Dollar-Bill Validato
FSU Card Chip Reader
Inkjet Printer
Large Format Printer
Laundry Controller
Microfiche
Mono Laser Printer
Multi-Coin Machine
Brand
Dell
Epson
HP
Konica
Kyocera
Lexmark
Minolta
Mita
Other
Samsung
Savin
Toshiba
Xerox
Model #
Serial #
*
* if applicable
Description of problem(s)
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