Credit Card Terminal Checkout Form
*Due to demand, the credit card terminal is checked out on a first come, first serve basis and
may only be checked out for a maximum of five days.
Pick Up Date:
Return Date:
Department:
Purpose:
Requested By:
Ext.
Date:
Accepted By:
Phone:
Date:
**For Offical Use Only**
Date Returned:
Total Charged To Index:
Returned By:
Ext.
Date:
Accepted By:
Ext.
Date:

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