Purchasing PO05
This form to be completed when an asset is being loaned or relocated off campus.
Is the equipment being loaned? Yes No
Is the equipment being relocated? Yes No
Name of person asset is being assigned to and who will be responsible for it (please print):
Relocation address of the asset: ____________________________________________________________________
Duration of time equipment will be off campus: ____________________________________________________
Provide description of asset, serial number and University tag number (if known):
Provide Department or Grant business number and account the asset was originally assigned to:
The equipment being borrowed or relocated off this campus is the property of the University of Windsor. You may
borrow or relocate this equipment for the duration indicated above and must return it at the time specified.
Please read and sign the following agreement to indicate your understanding and agreement with the terms and
conditions of this loan or relocation. This form also serves as an authorization to remove the described equipment
from the campus.
Responsibility Agreement:
I understand that by removing the University owned equipment described above, I am fully responsible for this
equipment while in my possession and promise to reimburse the University for its replacement value, if it is
damaged or stolen.
Your typed name below indicates your approval of the form and confirms that all information is accurate.
Signature of person responsible for the asset: ________________________________ Date: ____________
Equipment loan or relocation has been authorized by:
Name and Title at University (Please Print): ________________________________________________________
Signature: _______________________ Department and Ext. #: ___________________________________
Submit Form To: Capital Assets and Projects Clerk at capitalassets@uwindsor.ca. If there are any questions while
filling out the form, contact the Capital Assets and Projects Clerk at ext. 2121.