The University of Memphis
Request for Off-Campus Use of Equipment
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MEMORANDUM

To: Property Clerk, Property Section, Accounting Office

From:

Date:

Subject:  Use of University Equipment Off-Campus

In accordance with The University of Memphis Procedure No. 2D:01:01H, paragraph B4, this memorandum is:

Authorization for the U of M employee listed below to use the following equipment off-campus at the following location for University-related business only.
Notification that the following equipment has been returned to campus and is now located in Bldg. # , Room # .

Employee: Department:

Off-Campus Street Address:

City: State:  Zip:

Estimated Length of Time to Remain Off-Campus:

Decal
Description
Model Number
Serial Number

I, the undersigned, fully understand that University property removed from campus is not insured by the University while in transit or while in a private residence.  I understand insurance at other locations may be provided under certain circumstances as outlined in The University of Memphis Procedure 2D:01:06A (Insurance: Property, Liability, and Other).  I have also reviewed Procedure 2D:01:05A
(Reimbursement and Responsibility for the Loss or Damage of University Property Due to Negligence).
Authorization for use off-campus: Equipment returned to campus:
_________________________________     ______ _________________________________    ______
Employee Signature Date Employee Signature Date
_________________________________  ______ _________________________________  ______
Department Head Date Official Acknowledging Return Date