INDEX: DOC:
LAPTOP FORM
To: ____________________________ From: Megan Nash, Fixed Assets Department, ROF- Financial Operations, ext. 5248
NSU has provided the following computer equipment to you. Please complete and return this form to the Fixed Assets Department in recognition of your responsiblities for the care and safekeeping of NSU equipment. If this equipment needs to be or was removed from your possession please call OIT immediately at (954) 262-4900 and Fixed Assets at (954) 262-5248. Manufacturer: L1 Model: Service Tag / Serial Number:
Instructions:
1. If the green fields (L1 & L2) are not filled out, please fill in the appropriate information. If the fields are filled out, please verify that the information is correct as you will be responsible for this equipment. 2. After completing or verifying the information in the green fields (L1 & L2), print at least one copy. 3. Enter all information requested in the yellow fields (L3). Form must be signed and dated where indicated. 4. Return the completed form back to the person who sent it to you. Normally, this is the laptop contact person for your area/department. Incomplete forms will not be processed and will be returned. The laptop contact person should retain a copy for their own records. (Any questions contact ext. 5248)
NSU Tag Number: L2 Origination Tag: Delivered By: Received by
Building/Room: Purchase Order:
Center: Cost: Work Order: Received Date: Received Date:
Responsible Supervisor Name / Index Additional Parts / Comments:
This form is an agreement that the Signee (Responsible Party) for this laptop will be entrusted with the safeguard, care, and inventory of this equipment provided by NSU. The Signee will also be responsible for contacting the Police Department, Public Safety, and Fixed Assets if this laptop is ever lost or stolen. (Any questions contact ext. 5248) PRINT Responsible Party Name SIGN Responsible Party Name NSU ID # Date Signed Work Telephone Home Telephone Received Date Returned Date (First/Middle/Last) L3 / / / / / / ( ( ( ) ) ) ( ( ( ) ) ) / / / / / / / / / / / /
FOR OFFICIAL USE ONLY
Release from Responsibility The property control office was notified of the TRANSFER / RETIREMENT / RETURN of the property identified above. The named employee has been removed as the custodian of record. Returned to OIT (Tech Signature): Financial Operations Signature: ___________________ ___________________ Date: ______________ Date: ______________ Equipment Condition: ____________________ Initials for Data Entry : ____________________ Revised: 12/07/2006