Date_______________
Name_______________________ Company Name___________________________
Address______________________________________________________________
Phone________________________________ Fax____________________________
Email Address______________________________________________
I would like to check out the following item(s):
| Item Name |
Replacement Cost |
| |
|
| |
|
(no more than 2 at at time)
Please deliver these items to me via:
____ I will pickup at PIA-Texas ____ 2nd Day UPS
I agree to return material(s) by the date due (2 weeks from receipt).
If borrowed material is lost or damaged, I agree to pay all charges resulting,
including any replacement or processing charges. Borrower pays postage/delivery
fees to return item(s) to PIA-Texas. Items are for PIA-Texas members only
and not for reproduction.
Signature_________________________________________________
(signature required)
PIA-Texas use only:
Materials were sent _______________________ via _______________.
| Materials Due Back |
|
| Materials Returned |
|
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