Full Name: Status: Student Staff Faculty Other

Campus Phone: Barnard email:

Laptop Brand: Dell Fujitsu Other If other, write:

Model: Serial / Tag Number:

Why I need to borrow this laptop: 

USER STATEMENT: 

The Help Desk has given me these separate parts:

Laptop /  Power cord /  Floppy drive /  CD drive /  Carrying case  
Other parts listed in description above   

I will return the parts listed above to the Lehman Computer Center at this date and time:

Date: Time:

User's signature: ________________________________    Today's date: ________________

To be filled out by AT staff when the laptop is returned

The user has returned the laptop and the following parts in good condition

Laptop /  Power cord /  Floppy drive /  CD drive /  Carrying case  
Other parts listed in description above   

Date: Time:

AT staff signature: ________________________________    Today's date: ________________