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Equipment Loan Form
Please fill the form below
Tablet:
This field is required.Please enter value
Tag Name: (i.e. Cougar1 or Pheonix2):
This field is required.Please enter value
Includes:
USB Cable
Power Adapter
This field is required.Please enter value
Tablet Accessories (Cases, Stylus, etc.):
This field is required.Please enter value
Purpose:
This field is required.Please enter value
Main Location of Use:
This field is required.Please enter value
Loaned To:
Name:
First Name
Last Name
This field is required.Please enter value
This field is required.Please enter value
Department:
This field is required.Please enter value
E-mail:
This field is required.Please enter value
Please enter valid email address
Phone Number:
This field is required.Please enter value
Invalid phone number.
The value must be less than or equal to 20
Check Out
Checked out by same person that tablet is being loaned to?:
Yes
No
This field is required.Please enter value
Checked out by:
First Name
Last Name
This field is required.Please enter value
This field is required.Please enter value
Date:
This field is required.Please enter value
Date format is invalid, please check it again
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Time Out:
This field is required.Please enter value
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Date:
This field is required.Please enter value
Date format is invalid, please check it again
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Time to be Returned:
This field is required.Please enter value
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
I understand that I am responsible for returning the equipment listed above in the condition in which it was received and I willingly take responsibility to make certain that it is returned in the same condition. I accept financial responsibility for
I understand that I am responsible for returning the equipment listed above in the condition in which it was received and I willingly take responsibility to make certain that it is returned in the same condition. I accept financial responsibility for
This field is required.Please enter value
any repairs or replacement of lost or damaged items.
Submit
