Computer Check-Out Form
Please fill out this form to check out a computer.
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department
Date of Check-Out
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expected Return Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Computer
Laptop
Desktop
Computer Model
Serial Number
Condition of the Computer at Check-Out
Purpose of Check-Out
Acknowledgment
*
I agree to return the computer in the same condition as received and by the expected return date.
I do not agree.
Submit
Should be Empty: