Requester Name txtRequesterName Email txtRequesterEmail New Employee Name txtNewEmployeeName SitePrimary Location CorporateChaves CountyJefferson CountyLuna CountyMcClennan CountySan Miguel CountySandoval CountyTaos CountyValencia CountyComal CountyMcKinley CountyAnderson CountyLaramie CountyMIdland County select1111 Start Date dteStartDate Office 365 SubscriptionOffice 365 Subscription Business Standard (Office + Email) - $12.50/moBusiness Basic (Email, 50GB) - $5/moKiosk (Webmail, 2GB Storage) - $2/mo cboOfficeSubscription Email Address textbox4578 Machine IDTag# of machine Office is to be installed to textbox4195 CorEMR Position Administrative AssistantDeputyDoctorEMTFacility AdministratorHead NurseHealth Services AdministratorMedical RecordsMental HealthNurseNurse PractitionerPASecretarySystem Administrator cboPosition Other Additional Notes/RequestsType notes of anything not covered above. txtNotes Submit ‹›×× ×
