Shiffman Medical Library

Individual Service Order - Page 1

This form is for placing a new order with Media Services for equipment not for making changes to an existing order. Everything marked with a * is a required element. If you fail to fill in the required fields, your order may not be processed in a timely manner. If you have any questions, please call Media Services at (313) 577-1980, Mon-Fri 8am-5pm.

Contact Information
Today's Date: November 23, 2009

Division/Program*:

Contact Person*:

College*:

Office Phone*:

Contact's Email Address*:



Class Information

Instructor's Name*:

Instructor's Email:

Course No.* :

Section No. :

 

Building Information

Media Services only provides equipment to certain buildings. Choose a building below. If your class or event is in a building that is not in the list that follows, please call Media Services at (313) 577-1980 to make arrangements -- if possible. All general purpose classrooms in Old Main are now permanently equipped, so now ordering equipment for them is no longer required, check the rooms database for what is available.

If Building is Other:

Shiffman Medical Library
Wayne State University
Mazurek Medical Education Commons
320 E. Canfield St.
Detroit, MI 48201
(313) 577-1094