Equipment Off-Campus Form

Responsible Person *

Extension/Cell *

The number for contacting the "responsible person"

Contact Person

If different from the responsible person

Extension/Cell

The number for contacting the "contact person"

Department *

BYU Blue Tag Number *

Item 1

Item Description *

(include Manufacturer)
Item 1

Model *

Item 1

Serial No. or Service Tag No. *

Item 1

BYU Blue Tag Number #2

Item 2 (if applicable)

Item Description #2

Item 2 (if applicable)

Model #2

Item 2 (if applicable)

Serial No. or Service Tag No. #2

Item 2 (if applicable)

BYU Blue Tag Number #3

Item 3 (if applicable)

Item Description #3

Item 3 (if applicable)

Model #3

Item 3 (if applicable)

Serial No. or Service Tag No. #3

Item 3 (if applicable)

Purpose for taking equipment from campus *

Date item was taken from campus *

Date to be returned *

Where equipment will be located

Provide an address

I hereby acknowledge the receipt of University-owned equipment that I will be taking off campus to be used for University-related work. I realize this equipment will be subject to verification during any college physical inventory

I understand

Signature of Responsible Person *

Print your name here