Equipment Sanitization Request Form
Submit a request to have equipment professionally sanitized. Please provide all required details to ensure prompt and effective service.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Equipment Type
*
Please Select
Computer/Laptop
Laboratory Equipment
Medical Device
Office Equipment
Other
Equipment ID or Serial Number
Equipment Location (Building/Room)
*
Preferred Sanitization Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Sanitization Requested
*
Routine Cleaning
Deep Sanitization
Disinfection (COVID-19 Protocol)
Other
Urgency Level
*
Standard (Within 3 Days)
Urgent (Next Day)
Emergency (Same Day)
Additional Comments or Special Instructions
Submit Request
Should be Empty: