Equipment Loan Liability Waiver
Please complete this form to check out equipment and acknowledge liability for its care and return.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Affiliation
*
Equipment Item
*
Asset ID or Serial Number
*
Equipment Condition at Checkout
*
Please Select
Excellent
Good
Fair
Needs Attention
Loan Period Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Loan Period End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit Waiver
Submit Waiver
Should be Empty: