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CDC Employee Name & UserID:
* Date: *Check Out Time: * Check In Time:
Item(s) barcode:
Conditions of Use:
Eligibility
Loan Period
Fines and Damages
* Electronic Signature: The borrower agrees to be responsible for any damages/repairs necessary as the result of usage, prior to return of the property. The signature of the borrower indicates his acceptance of the device under the terms cited above.