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GIS REQUEST FORM
GIS MAPPING /PLOTTING REQUISITION
City of Jackson
Deparment of Administration
Information Systems Divis ion
353 South Congress St.
P.O. Box 17
Jackson Ms. 39205-0017
Email :
Gisrequest@city.jackson.ms.us
Personal Information
Name
Departmemt:
Division:
Company Name
Phone Number
Public Agency
Private or Personal Use
Request Information
DATE
Date Desired
Time Desired
Map Title
Quick View Link
Most Requested Maps
MAP SIZE
:
Quantity
A-8 ½ X 11 PRICE COLOR 5.00 BLACK LINE 2.00
B-11 X 17 PRICE COLOR 10.00 BLACK LINE 4.00
C-17 X 22 PRICE COLOR 15.00 BLACK LINE 6.00
D-24 X 36 PRICE COLOR 20.00 BLACK LINE 8.00
E-36 X 48 PRICE COLOR 25.00 BLACK LINE 10.00
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<tr> <td width="456"><div align="center" class="style2"> <div align="c Mr.Eugene Watt Phone: (601) 960.1853 <a href="mailto:Ewatt@city.jackson.m </div></td> </tr> </table> <br /> <span class="style5">Office Use Only:<br /> </span> <table width="293" height=" <tr> <td width="287" height="183" bgcolor="#CCCCCC">DATE RECEIVED <input name="textfiel <br /> ASSIGNED TO : <input name="textfield16" type="text" size="20" maxle <br /> FILE NAME: <input name="textfield17" type="text" size="20" /> <br /> PATH: <input name="textfield18" type="text" size="20" maxlength <br /> DATE/TIME COMPLETED: <input name="textfield19" type="text" size="10" /> <br /> PICK UP DATE: <input name=" <br /> PICKED UP BY <input type="text" name="textfield21" /></td> </tr> </table> <p> </p> <table width="398" height="105" bo <tr> <td width="290" height="101">send form <input type="submit" name="Submit" value="Submit" <br /> <br /> <strong><em>DISCLAIMER: </em></stron & </table> <br /> <table width="767" border="0"> </form> </body> </html>
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