Facilities Management
Special Setups Equipment Rentals
 


Choose one: Rental paid with a University Purchase Order. (Go to line 1.) 
                      Rental paid by Direct Customer Billing. (Go to line 5.)


Requestor Information - Paid with a University Purchase Order:
1. Name:  Department:  
2. Address: Bldg:  Room:
3. E-Mail:  Phone: 
4. Charge to University Purchase Order: Go to line 8.

Requestor Information - Paid by Direct Customer Billing:

5. Contact: Organization name: i.e. Red Cross, City of Fayetteville.

6. Street Address: City: Zip Code
.......Note: provide a postal type address including street, city, and zip code.

7. E-Mail: Phone: Go to line 8.

Event Information:

8. Event location:

9. Special Instructions:

10. Describe your event:

11. I'm not sure what equipment I will need, please contact me.

12. If you know what equipment you will need list items here:

13. Equipment to be delivered to and returned from event site by: Self Facilities Management (Event Rentals)

14. Setup and break down of equipment at event site by: Self Facilities Management (Event Rentals)

15. Date of need: Calendar date: Time of day: AM PM

16. Date of return: Calendar date: Time of day: AM PM

17. Event Contact (if different from above.) Name: Phone:

18. E-mail: 

If you have questions about this form,
contact Central Supply by phone at 575-3840 or by email.

Return to Special Setups Equipment Home Page