Custody Form - User Instructions
Name of Borrower:
PRINT the name of borrower.
CSULB ID#
Enter CSULB ID number of the borrower.
Due Date
Enter the anticipated due date that the borrower will return the equipment.
Address:
Enter the borrower’s home address.
City
Enter the borrower’s city.
State
Enter the state.
Zip Code
Enter the zip code.
Phone
Enter the borrower’s campus extension.
Enter borrower’s e-mail address.
Verified by
Enter the Record Keeper’s name. (The Record Keeper verifies the borrower’s information)
CSULB Property #
Enter the CSULB Property Tag number.
Description
Enter the description of the item.
Serial Number
Enter the item’s serial number if known, otherwise enter unknown.
Location Room/ Building #
Enter the location or building room number of the equipment.
Cost/ Value
Enter the cost or value of the equipment if known, otherwise enter unknown.
Purpose of loan
Check one of these: Instruction, Research, or Demonstration as the purpose for the loan. If none is applicable, check “Other” and describe it.
Period of Loan: (Specific dates)
Enter the date from which the equipment is borrowed and through the return date.
Under the paragraph: “I agree to assume…before __________due date”, enter the due date in the blank space.
Print name
PRINT the name of borrower.
Signature of Borrower
Signature of the borrower is required when the equipment is checked out.
Date
Enter the date when the equipment is checked out.
Name of the Department
Enter the department name.
Approved: Appropriate Administrator
Signature of the approved Administrator is required upon the release of equipment.
Date
Enter the date when the equipment is released.
Date of Return
Enter the date that the borrower returns the equipment.
Signature of Appropriate Administrator
Signature of the approved Administrator is required upon the return of equipment.