ORGANIZATION NAME
==================================================================

ACKNOWLEDGEMENT OF RECEIPT


Date: <DATE>

Item Name: FIELD<INVENTORY:ITEM_NAME>
Model: FIELD<INVENTORY:MODEL>
Model #: FIELD<INVENTORY:MODELNR>
Serial #: FIELD<ITEMS:SERIAL>
Barcode #: FIELD<ITEMS:BARCODE>
Condition: FIELD<ITEMS:CONDITION>
Issued To: FIELD<BORROWERS:NAME>
Issued On: FIELD<LOAN:LOANDATE>
Due Date: FIELD<LOAN:DUEDATE>

By my signature below I acknowledge receipt of the above-specified equipment.

Signature for Equipment Received: __________________

Printed Name: ______________________________________

This item remains the property of ENTER_ORGANIZATION_NAME. Loss, damage, 
or need for repair should be reported to the PERSON_NAME at TELEPHONE_NUMBER.


EQUIPMENT RETURNED


Date: _____________________________________

Condition: _____________________________________

Signature for Equipment Returned: _______________________________________

Printed Name: _________________________________________

Received by: ____________________________________________