Borrowed Equipment Request • Immersive

This for is to be used anytime an Immersive Employee or friend of the company borrows equipment.

Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Equipment Pickup Date*
MM slash DD slash YYYY
Equipment Pickup Time*

: Hours

Minutes
Equipment Return Date*
MM slash DD slash YYYY
Equipment Return Time*

: Hours

Minutes
Equipment Name 1*
Quantity*
Equipment Name 2
Quantity
Equipment Name 3
Quantity
Additional Equipment Names and Quantities
Please include any additional equipment with quantities here
Signature*
By checking the boxes below, borrower agrees to be financially responsible for any loss or damage to borrowed equipment. In addition borrower agrees to return equipment by the return date designated above. Borrower also understands that returning equipment late may incur a late fee up to the full rental price of the item for any days the item is returned late. Additionally a valid credit card form must be filled out and held on file with the Immersive Accounting Department before borrowing equipment.
- I agree to be financially responsible for lost or damaged items
- I agree to return all items on the return date indicated above
- I understand that late equipment returns may incur fees up to the full rental value of the item
- I agree to have a copy of a valid credit card on file with the Immersive Accounting Department

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