Equipment Request/Release Form
Borrower Name
First Name Last Name
Department
Date of Removal
Month Day Year
Date
Equipment Information
Number of Borrowed Equipment
Type of Equipment
IPAD Portable Laptop Cell Phone- IPHONE Cell Phone- Android preferred Windows Desktop Portable Printer/Scanner
Reason for Use
By signing below, the borrower acknowledges that he/she is responsible for the any damage to the items/equipment.
Borrower Signature
Clear
Additional Details/Comments
Authorized Name
First Name Last Name
Authorized Signature
Clear
Should be Empty:

Equipment Request/Release Form