COMPANY PROPERTY RECEIPT FORM
The following items have been issued to you:
Computer
Vehicle
Cell Phone
Keys
Credit Card
Business Cards
EZPass
Fuel Card
Uniform
Uniform
Uniform
Other (______)
Other (______)
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
Description_____________Qty______Date:_________Initials____
PRINT NAME:
Equipment Acknowledgment and Agreement
I acknowledge that I have received the Company property listed above. I agree that I will
return all property immediately upon termination of my employment with the Company. I
understand that if I do not return the property listed above, the costs of these items may be
deducted from my final pay per the Employee Deduction Agreement that I signed. I also
agree to use the Company property provided to me solely for the intended uses outlined
at the onset of my employment with Fielders Choice Enterprises, and as outlined in the
handbook. _______________
(employee/consultant initial)
PRINT NAME: __________________________________________________________
SIGNATURE: _________________________________DATE:_______________