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*Required field
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| Your Name:* |
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| Your Email Address:* |
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| Department:* |
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| Software Title:* |
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| Platform: |
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| License Type:* |
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| Software should be active from:* |
month:
- day
- year
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| Software should be active until:* |
month:
- day
- year
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| Support web page for this software, if applicable: |
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| Support ID, if required: |
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| Support Password, if required: |
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| Where would you like this software installed?1* |
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| Please provide any additional information you think
might help us assess your needs with regard to the
requested software: |
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Please enter the following security code:  |
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| 1Note:
If you think this software will have University-wide utility
and that it should be installed in all Labs, Classrooms, and
public areas in the Libraries,
type all. If you need it only in one room or a small
number of rooms, please specify in which lab(s) and/or classroom(s)
you need it installed.) |