Shared Economy & Gig
Equipment Receipt Acknowledgment
Equipment loan and receipt acknowledgment for tracking organization-issued equipment. Single signer (recipient).
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# Equipment Receipt Acknowledgment **Date:** ___________ This Equipment Receipt Acknowledgment ("Acknowledgment") is made by: **Recipient:** ___________ ("Recipient") **Organization:** ___________ ("Organization") ## 1. Recipient Information **Position or Title:** ___________ **Department:** ___________ **Work Location:** ___________ **Employee/Contractor ID:** ___________ ## 2. Equipment Details **Equipment Item 1:** - Description: ___________ - Make/Manufacturer: ___________ - Model: ___________ - Serial Number: ___________ - Asset Tag Number: ___________ - Condition at Receipt: ___________ - Estimated Value: $___________ **Equipment Item 2 (if applicable):** - Description: ___________ - Make/Manufacturer: ___________ - Model: ___________ - Serial Number: ___________ - Asset Tag Number: ___________ - Condition at Receipt: ___________
Fields (38)
receipt date
date · required
recipient name
text · required
organization name
text · required
position
text · required
department
text · required
work location
text
employee id
text
item1 description
text · required
item1 make
text · required
item1 model
text · required
item1 serial
text · required
item1 asset tag
text
item1 condition
select · required
item1 value
text · required
item2 description
text
item2 make
text
item2 model
text
item2 serial
text
item2 asset tag
text
item2 condition
select
item2 value
text
item3 description
text
item3 make
text
item3 model
text
item3 serial
text
item3 asset tag
text
item3 condition
select
item3 value
text
additional items
textarea
accessories
textarea
loan purpose
select · required
loan duration
select · required
return date
date
report period
select · required
damage liability
select · required
governing state
select · required
recipient signer name
text · required
recipient signer title
text
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