Fill - Free fillable Equipment-request Equipment/Camera Request PDF form

OFFICIAL REQUEST: For use of equipment/camera

I would like to request permission to use the following equipment from the Ofce of Administrative Services and

Marketing

____ Nikkon Camera

____ Camera lens

____ Lens cap

____ Memory card (4gb or 8gb)

____ Camera Bag

____ Other. Please explain: _______________________________________________________________________________

The equipment will be used for the following purpose:

The equipment will be used on the following date(s): ____________________________________________________________

I agree to pick up the aforementioned equipment on: ____________________________at ____________________________

(please indicate time) (please indicate date)

I agree to return the aforementioned equipment to the on: ________________________at ___________________________

(please indicate time) (please indicate date)

I, ________________________________________, the undersigned, understand that this equipment is the sole property of

the Ofce of Administrative Services and Marketing. If the equipment, or any portion of the equipment, is lost or

damaged, I accept full responsibility for its replacement, repair or reimbursement, as determined by the Ofce of

Administrative Services and Marketing

Borrower’s Name: (Please print) ___________________________________________________________________________________

Email: ____________________________________________________Telephone: __________________________________________

Address: _______________________________________________________________________________________________________

Student organization, club, or ofce afliation: ___________________________________________________________________

Borrower’s Signature: ____________________________________________________Date __________________________________

All request must be approved by the Department Head before submitting to the Ofce of Administrative Services

and Marketing.

Name of Director/Department Head: (Please print) ________________________________________________________________

Email: ____________________________________________________Telephone: __________________________________________

Signature of Department Head (i.e. director): _____________________________________Date: _________________________

Please submit this form via email to studentmkt@nova.edu or drop off to the Office of Administrative Services and

Marketing at least one week before the date of equipment pickup, so we can let you know of availability. You will

then receive and email confirmation from us. Please contact studentmkt@nova.edu regarding this request.

Fill Online, Printable, Fillable, Blank Equipment-request Equipment/Camera Request Form