Checkout and Liability Form
Laptop Service Tag Number: _____________________________
Value: $ 1,000.00 (Includes: DELL Latitude 3500 CTO with i5-8 265U Processor (4 Core, 1.6GHz up to 3.90 GHz), 8gb RAM,
512gb HDD, Windows 10 Enterprise 64 bit, battery, case, power supply and backpack)
Name: ____________________________________________________________ EmplID: _____________________________
Address: ___________________________________________ City: ___________________________ST: ______Zip: _______________
Phone: (home)_______________________________(cell)_____________________________(work)______________________________
As the Borrower, you have been provided with the loan of a laptop with the above Service Tag No. In consideration of the
right to use this laptop computer, the Borrower agrees to abide by the following terms and conditions:
1. The Borrower agrees to keep this laptop in his or her custody and agrees not to lend, loan, or otherwise provide it to
any other person. The Borrower agrees not to use this laptop to violate any State or Federal Laws with regards to
trademark, copyright, patent, libel, slander, or privacy of electronic data communication.
2. The Borrower agrees to inform Southwest Virginia Community College immediately of any problems, malfunctions,
damages, and loss or theft of the laptop, and agrees to assume all responsibility for any damage, loss, or theft of the
laptop during the loan period. All costs associated with the loss, theft, or damage to the laptop while on loan to the
Borrower shall be the sole obligation of the Borrower and shall be billed to the Borrower’s student account, subject
to all collection costs, including attorney’s fees, and the withholding of transcripts and degrees until this financial
obligation is met.
3. The Borrower agrees to return the laptop and all included accessories to Southwest Virginia Community College
within 48 hrs, in the same condition as on the agreement beginning date. At the Southwest’s discretion, the loan
period may be extended for up to a week.
4. A late fee in the amount of $25.00/day will be charged for not returning the laptop on the due date. If the
Borrower needs a laptop for a longer period of time, he or she must return the laptop in person on
the agreed return date and check out a different one. (Subject to availability.)
DUE DATE: _________________________
5. No data should be stored on the laptop’s hard drive by the Borrower. All files stored locally will be deleted upon
return of the laptop. Southwest Virginia Community College is not responsible for any loss of data or any problems
arising from this.
Laptops not returned within 48 hours of the agreed upon return date will be considered stolen. Campus police will be contacted
and a hold will be placed on your Southwest account. Individual cases may be referred to the Dean of Student Success office for
disciplinary action.
I hereby acknowledge the receipt of the above listed property in the conditions specified in the Existing Damage Report Form
(initial _____) and am aware of the responsibility for its care and return. Furthermore, I authorize Southwest Virginia
Community College to charge any liabilities arising under this agreement against my Southwest student account.
_________________________________________________ ___________________
(Borrower’s Signature) (Date)
Checkout and Liability Form
Equipment distributed by: ______________________________________________ ______________________
(Authorized Staff Signature) (Date)
Equipment received by: _________________________________________________ ________________________
(Authorized Staff Signature) (Date)
Condition of Equipment: ____________________________________________________________________________