IIDF Work Request Form

Customer Name:
Email:
Telephone:
Fax #:
Department:
Organization:
Address 1:
Address 2:
City:
State:	Zip:
Job Description:

Materials:

Special Treatments:

Comments:

Work Specific Shop (check all that apply):
System Design Machine Shop Electronics Shop Glass Shop Repair/Maintenance
Rates: Machine and Glass Shops Internal: $63/hr External: $70/hr Electronics Shop Internal: $66/hr External: $75/hr Repair Shop Internal: $50/hr External: $55/hr
Desired Delivery Date:

Cooperative Institute for Research in Environmental Sciences