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De La Salle University

INFORMATION TECHNOLOGY SERVICES OFFICE

SERVICE EQUIPMENT REQUEST FORM

Requested By:
Name :

ID Number :

Office / Department :

Contact No. /Email :

NOTE : 3 days lead time is

necessary for request which need
approval.

School Organization (if applicable) :

Date Needed :

Time Needed :

to

Venue :

Due Date :

In case the damage or loss is the fault

of the movers, or borrowers representative to check-out / check-in the
equipment to ITS, the office or department concerned will still be charged
for the costs.

Equipment to be borrowed :
unit/s Extension cord

unit/s Laptop
unit/s

unit/s Remote Control

LCD Projector

I agree that the cost of the lost

equipment borrowed from ITS will be
charged to the office or department
where I belong.

Equipment returned late is subject

to a fine of P50.00 per equipment
per hour. Borrowers with unsettled
accounts will not be allowed to borrow any equipment until the overdue
payment has been settled.

Purpose:

Borrowed by :

The office or department is accountable until the borrowed equipment is

received by ITS.

Returned by :

Print name and Requesters Signature

Date Taken :

Time :

List of equipment & accessories

Laptop Brand & Model no.

Print name and Requesters Signature

Date Returned :

Time :

Conforme:

List of equipment & accessories

Laptop Brand & Model no.

Power Cord

Power Cord

Adaptor

Adaptor

Extension Cord

Extension Cord

Mouse
Projector Brand & Model no.

Mouse
Projector Brand & Model no.

VGA Cable

VGA Cable

Power Cord

Power Cord

Print name and Requesters Signature

Print name and

Office / Department Heads Signature

To be accomplished by ITS if request is for non-DLSU and outside DLSU activities / events

Remarks

Approved by

Date

07062011_its_service-equip-request.indd