UCSD Printer Refresh Program

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Printer Exchange Request Form

Name:

*You may not fill this form on behalf of someone else.

Department:

UCSD email address:

UCSD phone number:

Please provide the charge account for the $30 administration fee. If unsure, please reach out to your fund manager.

Fund manager's name and email address:

What is the make and model number of the printer you are replacing? (i.e. OfficeJet Pro L7580)

What is the printer's UCID Number (if applicable)?

Please see eligible printers below:
*requests for other printers will be reviewed on a case by case basis.

Please indicate which printer you would like to request.

Pickup/Drop-off location (i.e. Building Name, Room # and special instructions, if any): Pickup of the old printer will occur 7-10 business days following delivery of the new printer. Please specify if any alternate arrangements should be made. Failure to turn in the old printer within 7-10 business days will result in a charge for the full price of the new printer.

Building name

Room #

Mail Code

Additional comments

Supervisor's email address:

Has your supervisor given approval for this printer exchange?

In order to qualify for this program, the requestor must be on delivery location for a full business day or until the printer is received. By selecting "I Agree," I acknowledge that I must be onsite for delivery of the new printer.

I Agree

Do you agree to our Terms and Conditions? By selecting "I Agree," I acknowledge that I have read all the above information and that the information provided above is complete and accurate to my knowledge. I understand that the handling charge is non-refundable. If the current printer model above does not match the physical printer offered at the time of pickup, I agree to forfeit the handling charge and accept the invalidation of my printer exchange request.

I Agree