Equipment Lifecycle Extension Request Form
Submit a request to extend the operational period of your equipment. Please provide all required details for review.
Requester Full Name
*
First Name
Last Name
Department
*
Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Equipment ID or Serial Number
*
Equipment Type
*
Please Select
Computer/IT Equipment
Machinery
Vehicle
Medical Device
Other
Equipment Location
*
Current Condition of Equipment
*
Excellent
Good
Fair
Poor
Requested Extension Period (in months)
*
Justification for Extension Request
*
Attach Supporting Documents (e.g., maintenance logs, inspection reports)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Supervisor/Manager Name for Approval
*
Supervisor/Manager Email
*
example@example.com
Submit Extension Request
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