Equipment Loan Form

Fairfield Public Library
Equipment Loan Form

Date of requested use:
Person responsible for room:
Phone (day): (night):
Library Card # (Must have FPL account to check out AV):
Check Out: Date Time
Return: Date Time

I understand that I am responsible for the AV materials I am checking out. I shall pay the full cost of any repair or replacement made necessary by my action or neglect. I shall return the materials to the library at the agreed-upon time. Overdue fines may be assessed at $2 per hour, maximum $10 per day.

_______ _________________________________________________________
Date Signature of responsible person (Sign on day of check-out)

For Staff Use Only	*Must have library card to check out AV equipment. Check the patron's record and advise him/her of any fines.*
Checked patron record:	Checked (date): ________	Staff initials: _____
Deposit amount: ____________	Received (date): ________ Returned (date): ________	Paid by: Cash___ Check___ Staff initials: _____ Staff initials: _____

16 mm projector	3 days	$20.00	Microphone stand	3 days	$20.00
16 mm reel	3 days	$20.00	Opaque projector	In library use only	No deposit
Amplifier	3 days	$20.00	Polaroid camera #_____	2 weeks	No deposit
Cassette player recorder #_____	2 weeks	$20.00	Portable mic system	3 days	$20.00
Easel # _____	3 days	$20.00	Portable PA system	3 days	$20.00
Extra slide projector carousel #_____	3 days	$20.00	Projector screen #_____	3 days	$20.00
Foldup transpar. projector	3 days	$20.00	Slide Projector #_____	3 days	$250.00
Hand held microphone	3 days	$20.00	Stationary trans projector	3 days	$20.00
LCD projector #_____	3 days	$250.00	Vision better-ment machine	No deposit	Indefinite checkout
Master lens device	1 month	$20.00

Fairfield Public LibraryEquipment Loan Form

For Staff Use Only

Fairfield Public Library
Equipment Loan Form