Contact Information
Contact Name
Title
Requesting Assistance / Requested Resources
Delivery Location
Delivery Site Address

**NOTE** The organization requesting the equipment will be responsible for picking up the requested resource as well as returning it to the training site it was picked up from.

Comments
Acknowledgement

By signing below, I, the requestor, acknowledge and understand that I will assume full responsibility for the care and maintenance of the requested resource. I understand and acknowledge that there may be costs associated with requesting the resource as well as maintaining the equipment. I also acknowledge that the requesting organization will pick up and return LESTA owned equipment to the training site it was procured from.