Equipment Checkout Form

E-mail address (required):

Name:


NOTE: This equipment is intended for short-term loan (maximum 1 week).  If you need to make multiple reservations, use the comments box to list the dates and times. If you need a laptop for long-term loan (i.e. most or all of a semester), use the comments box to make your request and we will provide one from our surplus equipment if available.

Item(s) requested :
Dell Laptop PowerBook LCD Projector

Pickup Date: & Time:

Return Date: & Time:

Location where equipment will be used:

On Campus (including DTC): Building & Room #
Off Campus

Comments: