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CoEHS Loaner Reservation Form

Please complete the form carefully. Note that there are required fields in the form.

Requests for equipment should be made at least one business day in advance. Loaner equipment is checked in/out Monday-Friday 8:00 am to 4:00 p.m. Allow at least 15 minutes for both procedures.

 

 Review Loaner Policy (pdf document)

 
 
(Required)
(Required)
(Required)
/ /
(Required)
First & Last Name(required field)
(Required)
Phone number you can be contacted at if there are questions(required field)
(Required)
(Required)
(Required)
(date to pickup item - time to pickup item)
/ / :
(Required)
(date to return equipment - time to return equipment)
/ / :

 

You will receive an email confirming your request within 24 hours.
 

Copyright 2012 The Board of Regents of the University of Wisconsin System

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