Authorization and Custody Record Form
Complete this form to record authorization and custody transfer details. Please provide accurate information for traceability.
Name of Authorizing Person or Entity
*
First Name
Last Name
Name of Custodian/Recipient
*
First Name
Last Name
Contact Email of Custodian/Recipient
*
example@example.com
Contact Phone Number of Custodian/Recipient
Please enter a valid phone number.
Format: (000) 000-0000.
Date and Time of Transfer
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Description of Item or Asset Transferred
*
Quantity or Serial/Reference Number (if applicable)
Location of Transfer
Purpose or Reason for Transfer
Authorized Signature
*
Submit Record
Submit Record
Should be Empty: