LOAN AGREEMENT FORM

GEORGIA INSTITUTE OF TECHNOLOGY
EQUIPMENT LOAN AGREEMENT
DATE _________________
I, ________________________________ request permission to carry equipment, identified below, belonging to Georgia Tech off campus to _______________________________________________________________________________________________
for the following reason: ___________________________________________________________________________________
_______________________________________________________________________________________________________
IMPORTANT: All equipment taken off campus must be listed if its value is above $99.99.
Inventory Replacement
Number Description Serial No. Model No. Cost
__________ ___________________________ ____________ ________ __________
__________ ___________________________ ____________ ________ __________
__________ ___________________________ ____________ ________ __________
__________ ___________________________ ____________ ________ __________
__________ ___________________________ ____________ ________ __________
_______________________________ ___________________________________________
Employee Signature Department Head/Lab Director Approval
and Phone No.
_______________________________ ___________________________________________
Employee ID No. Department Name (Print)
NOTE: 1. This equipment can only be used in the performance of your official duties for Georgia Tech.
2. This form is to be maintained in the Department Property Coordinator’s Office while equipment is off site.
3. Update Asset Management System when equipment is returned.
___________________________________________________________________________________________________________
INVENTORY FORM NO. 6
Revised 6-2002
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