2. 

4. City of St. Pete Beach Equipment Loan Agreement

6. Item Description / Model*
7. City Tag ID#
9. Included Accessories*

   1. N/A
   2. Power Adapter
   3. Mouse
   4. Keyboard
   5. Hotspot
   6. USB/ Any Accessory Cable(s)
   7. Case
   8. Other (If Yes, please describe below)
11. Purpose of Use*
12. Main Location of Use

14. Loaned To:

16. First Name*
17. Last Name*
19. Phone Number*
20. Email Address*
22. Department*

24. Check Out

26. Checked out by same person that equipment is being loaned to?*

    1. Yes
    2. No

28. Checked Out By:

30. First Name
31. Last Name
33. Date / Time Checked Out*
    Date / Time Checked Out

    Date / Time Checked Out
34. Date / Time To Be Returned
    Date / Time To Be Returned

    Date / Time To Be Returned
36. Electronic Signature Agreement

    I understand that I am responsible for returning the equipment listed above in the condition in which it was received, and I willingly take responsibility to make certain that it is returned in the same condition. I accept financial responsibility for any repairs or replacement of lost or damaged items.

    1. I agree.
38. Electronic Signature
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field