Card Terminal Rental Form
Office of the Bursar ∙ Student Center E172 ∙ (303) 273-3158 ∙ bursar@mines.edu ∙ www.mines.edu/bursar Updated: 4/28/2020
The Bursar’s Office has two card terminals that student organizations and departments can rent for campus related events.
Card terminal requests are processed on a first-come, first-served basis so the requestor is encouraged to submit this form
one-week prior to the requested pick-up date. Due to demand, the terminal can only be checked out for a maximum of 5
days at a time.
In
order to be eligible to rent the card terminal, the requestor must have at least $700 in their index to cover the replacement
cost in the event that the terminal is not returned or returned damaged. Approval from the Student Activities Involvement
and Leadership (SAIL) Office or department Fiscal Manager is required for all rentals. Additionally, the index provided will
be assessed a non-refundable 2.75% convenience fee of the total amount transacted at the end of the respective quarter.
Req
uestor Information:
Department/Student Organization: _________________________________________________________________________________
Cam
pus Related Event/Purpose: __________________________________________________________________________________
Da
te Requested: __________________ Requested Pick-up: __________________ Return Date: __________________
If the terminal is not returned or returned damaged, charge the following index: __________________________________
SAIL/Fiscal Manager Approval:
I certify that the student organization or department listed above has at least $700 in their index.
Printed Name: _________________________________________________________ Extension: ____________________
Signature: _________________________________________________________ Date: ____________________
Student Organization/Department Acknowledgement:
I understand that if I do not return the card terminal by the return date or the terminal is returned damaged, the index
listed above will automatically be charged $700. I also understand that the index provided will be charged a non-
refundable 2.75% convenience fee of the total amount transacted by the end of the respective quarter.
Printed Name: _________________________________________________________ Phone: ____________________
Signature: _________________________________________________________ Date: ____________________
CA
SHIER OFFICE USE ONLY:
Picked up by: ______________________________________ Phone: ___________________________ Date: ____________________
Returned by: ______________________________________ Phone: ___________________________ Date: ____________________
Accepted by: ______________________________________ Index charged? Yes No Amount: ____________________
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