Scissor Lift Extension Request Form
Submit this form to request approval for extending the use or loan period of a scissor lift. Please provide accurate details to ensure timely processing.
Full Name
*
First Name
Last Name
Department or Team
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Scissor Lift ID or Serial Number
*
Current Loan End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Extension End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Extension
*
Supervisor or Manager Name
Additional Comments (if any)
Submit Extension Request
Should be Empty: