Fiedler Library Laptop Checkout Form

Equipment Checked Out: Date:___/___/___ Time: ___:___

Checked out by (FEL Staff): __________________________

	Laptop Number	Library Asset Tag
	Laptop #1 (31676132)	A11500517019
	Laptop #2 (31671046)	A11500517027
	Laptop #3 (31671047)	A11500517035
	Laptop #4 (31671048)	A11500517043
	Laptop #5 (31671049)	A11500517051
	Laptop #6 (31671050)	A11500517069
	Laptop #7 (31671051)	A11500517077
	Laptop #8 (31671052)	A11500517085
	Laptop #9 (31671053)	A11500517093
	Laptop #10 (31671054)	A11500517108

Equipment - verify checkout	Checked-Out?
1 Gateway 450E Laptop	Yes	No
1 AC power adaptor with cords	Yes	No
1 Laptop carrying case with shoulder strap	Yes	No
1 User instruction card	Yes	No
(Optional) 1 Network cable	Yes	No
(Optional) 1 Modular 3.5" floppy diskette drive	Yes	No

Returned: Date: ___/___/___ Time: ___:___

Checked in by (FEL Staff): ______________________

On Time: _____ Late: _____ Charge: ___________

Equipment - verify checkin	Checked-In?
1 Gateway 450E Laptop	Yes	No
1 AC power adaptor with cords	Yes	No
1 Laptop carrying case with shoulder strap	Yes	No
1 User instruction card	Yes	No
(Optional) 1 Network cable	Yes	No
(Optional) 1 Modular 3.5" floppy diskette drive	Yes	No

Terms and Conditions

• Bring the laptop back on time
• Return the laptop to Fiedler Library circulation desk when finished
• Do not take the laptop out of the Durland/Rathbone/Fiedler building complex.
• Do not leave the laptop unattended
• Do not loan the laptop to others
• Laptops will only have wireless network access in areas with wireless coverage

There will be an overdue fee of $5.00/hr for laptop(s) not returned on time. This time will start 1 minute after the checkout period has expired.

"I agree to pay all costs associated with damage to this laptop computer or its associated peripheral components or replacement costs should it be lost or stolen. I understand that the replacement cost for this laptop will be no less than $2400 plus overdue fines and a non-refundable $10 processing charge."

I have read and agree to the above terms and conditions

Print Name Signature