Annual Equipment Review
User Name
*
First Name
Last Name
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Department
*
Please Select
Claims
Information Systems
Commercial Lines Underwriting
Personal Lines Underwriting
Accounting
Business Analytics
Product Management
Project Management
Sales
Corporate Services
Administration
Equipment Type
Please Select
Printer
Laptop
Scanner
Surface
Monitor - Home
Monitor - Office
iPad
iPhone
Android
Asset Tag/Serial #
Equipment Type
Please Select
Printer
Laptop
Scanner
Surface
Monitor - Home
Monitor - Office
iPad
iPhone
Android
Asset Tag/Serial #
Equipment Type
Please Select
Printer
Laptop
Scanner
Surface
Monitor - Home
Monitor - Office
iPad
iPhone
Android
Asset Tag/Serial #
Equipment Type
Please Select
Printer
Laptop
Scanner
Surface
Monitor - Home
Monitor - Office
iPad
iPhone
Android
Asset Tag/Serial #
Equipment Type
Please Select
Printer
Laptop
Scanner
Surface
Monitor - Home
Monitor - Office
iPad
iPhone
Android
Asset Tag/Serial #
Equipment Type
Please Select
Printer
Laptop
Scanner
Surface
Monitor - Home
Monitor - Office
iPad
iPhone
Android
Asset Tag/Serial #
Equipment Type
Please Select
Printer
Laptop
Scanner
Surface
Monitor - Home
Monitor - Office
iPad
iPhone
Android
Asset Tag/Serial #
Note any changes in box:
Signature
*
Submit
Submit
Should be Empty: