EagleBucks Tech Checkout Request
Request must be submitted at least 3 business days prior to first collection date
Name: _______________________
Club: ________________________________________
E-mail Address: __________________________
Phone: __________________________
Description of event: ___________________________________________________________
________________________________________________________________________
Collection Date(s): _______________________________________________________
Start Time: ___________________ End Time: ______________________________
Amount to be charged: $__________________________________________________
Statement of Responsibility
I, ____________________(Name), as the steward of _______________ (Club) for the term of this
agreement, understand that:
• The EagleBucks reader covered by this agreement has an estimated monetary value of
$4000.
• ________________ (Club) is responsible for any damages to the EagleBucks reader and will
be responsible for reimbursing the Club Sports Office for any damages to it, including
purchasing a replacement if necessary.
• The duration of this loan shall be from ______________ until ______________.
EagleBucks Policies
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For EagleBucks Tech Checkout Requests, the individual listed in the agreement above must
be in possession of the equipment at all times.
EagleBucks funds will be deposited into the borrowing Department/Organization’s account
within 5 business days.
Funds collected by EagleBucks must be associated with the sale of an item or service (i.e.,
EagleBucks cannot be collected for penalty fees, donations, or other expenditures).
___________________________________
Club Treasurer Signature
______________
Date
___________________________________
Club President Signature
______________
Date
Club Sports Office Use Only
TCR# _________________________
Return Date____________________