Request to Borrow Equipment and/or Supplies

Name

E-mail Address

What equipment or supplies do you wish to check out? Please list the name and quantity of items.

Why do you need to check out these items?

What day do you wish to check out the items?

What day do you anticipate returning the items?

By signing, I agree to return all equipment and/or supplies clean and in proper working order. I understand that I am responsible for replacing any equipment or supplies that may be damaged or that become lost or stolen. I understand that a hold may be placed on my university account which may prevent registration or release of transcripts until the item(s) is/are returned or paid for in full.

Sign above