This form is to be completed by USI EMPLOYEES to borrow equipment for university-related activities ONLY, and is NOT FOR PERSONAL USE. A university account number is required- charges may apply. Questions? Call us at 812.465.1080.

* 1. Please type your name.

* 2. Please type your complete EMAIL address.

* 3. Type the telephone number where you may be reached if we have any questions.

* 5. Please have the fiscal agent email IT their approval and provide an account number.This account will be charged in the event the equipment is damaged.

* 6. State the meeting or the purpose for the loan.

* 7. Select the equipment you need from the list below:

* 8. Didn't see what you need on the list above?

* 9. What date do you need to pick up equipment?

* 10. Type the time you need to pick up the equipment. PICK-UP TIMES ARE: M-F 8:00 a.m. to 4:15 p.m.

Pick up time:

* 11. What date will you return equipment?

* 12. Time you will be returning equipment. RETURN during business hours: M-F 8 a.m. to 4:15 p.m.

Return time:

* 13. IF THIS DOES NOT APPLY, skip question. Select box if you have questions or need assistance.

PLEASE PRINT A COPY of this completed form for your records and review it before continuing.