IT Services Server Request Form

Covers a server request from end to end: who is asking, the environment and machine type, public exposure, SSL certificate, disaster recovery, handling of personal data, remote access, CPU, memory and storage sizing, business justification, budget and the date it is needed. It then routes through department and IT leadership signatures and leaves room for the administrator to record the final build. Built for IT departments with a formal provisioning process.

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Requester details

Requester name

Date of the request

Department

Job title

Office location

Phone

Email address

Service desk request number

Environment (tick only one)

Production Staging Development Test

Type of server

Physical server Virtual machine Cloud instance Container platform

Server information

Manager or supervisor

Supervisor's email

If this is for a new public-facing site (tick only one)

Is an SSL domain certificate required?

Domain certificate name

Does this system need to be available during disaster recovery?

Proposed server name

Final server name

Will this server hold or serve personally identifiable information?

It will hold no personal data Employee data Customer data Health data Payment or card data

Which company owns the server?

Technical owner (first and last name)

Backup owner (first and last name)

Will remote desktop or SSH access be required?

Remote desktop SSH access Through VPN only No remote access

Usernames that need local admin rights (comma separated)

Usernames with standard access (comma separated)

Server type requested

Server location

Target environment

Will backups be required?

Backup requirements

Other backup requirements

Suggested server name

Operating system

Server sizing

Number of CPUs

Amount of memory (GB)

Extra storage (GB)

Other services or applications

Business need: explain why the server is required

Will this server replace an existing system?

If so, which server does it replace and when can that one be decommissioned?

When is the server needed by? Allow at least 5 business days

Pricing model: on demand or reserved

Annual on-demand budget

Annual reserved budget

Print name

Date

Signature of the server requester

Sign here

Departmental approval

Name of the senior manager or approved individual

Date

Department lead signature

Sign here

Name of the IT director or VP approving

Date

Signature of the IT director or VP

Sign here

For systems use: build details

Service tag or serial number

Asset tag number from inventory (if physical)

Assigned VLAN

Private IP

Public IP (if required)

External ports

External IP ranges allowed access

Internal ports

Internal IP ranges allowed access

Website URL

Is intrusion detection or prevention (IDS/IPS) required?

Notes or other requirements

Print name

Date

Systems administrator signature

Sign here

What happens after you submit

Service desk contact

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