E3 6/98
CAMERON UNIVERSITY
EQUIPMENT CHECK-OUT REQUEST
CHECK-OUT INFORMATION
(To be Completed by Person Submitting Request)
Name Home Address Home Phone Office Phone
Purpose for which equipment is requested:
Location to which equipment will be moved:
Requested Check-out Period:
From:
(Hour) (Date)
To:
(Hour) (Date)
Signature of Person Requesting Equipment
INVENTORY CONTROL INFORMATION
(To be completed by Dept furnishing the requested equipment.
Information must be from the official inventory listing)
Name of Inventory Account Inventory Account Number
Control # CU Tag # Serial Number Bldg. # Room #
Inventory Description Department Description
APPROVED DISAPPROVED
Department Chair or Equipment Supervisor
Division Head or Unit Director
VERIFICATION OF RETURN OF EQUIPMENT
Returned
(Hour) (Date)
Department Chair or Equipment Supr.
Distribution: 4 copies upon check-out and return; 1 copy each signatory, 1 Business Office
