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2. Village of Germantown I.T. Assistance Request Form
   Please fill out all applicable categories. NOTE: This form is intended for Village of Germantown Employees.
4. Name
5. Phone Number
7. Building / Location

   1. Department of Public Works
   2. Fire Station 1
   3. Fire Station 2
   4. Police Department
   5. Senior Center
   6. Village Hall
8. Concern is Regarding

   1. Computer Hardware
   2. Computer Software
   3. Printer
   4. Email
   5. Phone
   6. Networking / Server Access
   7. Other
9. Priority Level

   1. 1 - Address as time allows
   2. 2 - Within 2 Weeks
   3. 3 - Within 1 Week
   4. 4 - Within 1 or 2 Days
   5. 5 - Immediate
11. Specifics
    Please specify the details of your concern including the frequency of the issue and any errors you are receiving.
15. FOR I.T. STAFF ONLY
17. Completed By
18. Date Completed
19. Time Required to Complete
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field