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Print/Copy Request Form
Building Services – Print/Copy Request
Name
*
Email
*
Phone
*
If HIPAA document: Reference #
Upload Original File
Drop a file here or click to upload
Choose File(s)
Maximum file size: 25MB
Number of Pages
*
Total count of pages in the original file (two-sided pages = 2)
Number of Copies
*
Preferred Completion Date
*
PAPER type
*
Standard Paper
Cardstock
PAPER colors
*
White
Green
Pink
Ivory
Blue
Yellow
Gold
CARDSTOCK colors
*
White
Blue
Ivory
Type of PRINTING
*
Black and white
Color
PAPER size
*
8.5″ x 11″
8.5″ x 14″
11″ x 17″
Letterhead
Poster (specify size)
Requesting copies to be (select all that apply):
*
Like the original – ONE SIDED
Bi-Folded
Like the original – TWO SIDED
Tri-Folded
CREATE a two sided copy
Special Folded
Collated only
3 Hole Punch
Collated/Stapled
Cut (as originals)
Book stapled
Special Instructions
Fiscal Information
Please enter your Grant Number
OR
General Fund DAX String below (
Click here for the DAX Conversion Listing
)
Order will not be processed without correct fiscal information.
What fund will be charge for this print job?
*
Grant
Funding String
Grant #
*
G50XXXX
Division
*
Addiction Services
Administrative Services
Clinical Health
CPHI (Center for Public Health Innovation)
Environmental Health
Family Health
Health Commissioners Office
Neighborhood Social Services
Population Health
Sexual Health Promotion
Fund #
*
i.e. 2250, 2251, etc
Program
*
i.e. CW001, HE002, etc
Section 3
*
i.e. 500XXX
Section 4
*
i.e. HE09, HE27, etc
If you are human, leave this field blank.
Submit
