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Lost, Stolen or Broken VI Technology Equipment
Description of VI Technology equipment on loan by district that is lost, stolen or broken
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* Indicates required question
Email
*
Your email
Name:
*
Your answer
District:
*
Your answer
Equipment name and Serial #:
*
Your answer
Lost, Stolen or Broken
*
Lost
Stolen
Broken
Explain what is going on with Equipment
*
Your answer
Did you reach out to Vendor
*
Yes
No
Other:
Who did you contact
*
Christal Vision
Humanware
HIMS
Region 4
Other:
Case # and who you spoke with
Your answer
Date
*
MM
/
DD
/
YYYY
Phone # where you can be contacted
*
Your answer
Thank you for reporting the need of the VI Technology, please hit send.
If you do not hear from Region 4 Staff within a week, please contact Alisa McCarty at 713-744-6339
DATE Mailed for Repair:
MM
/
DD
/
YYYY
Cost of Repair:
Your answer
Received from Repair on:
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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