ACKNOWLEDGEMENT OF RECEIPT OF COMPANY PROPERTY

Name:

Date:

Description of Equipment or Property Issued to Employee:

1.

2.






By signing this form, I agree to the following:

• I am responsible for the equipment or property issued to me;
• I will use it/them in the manner intended;
• I will be responsible for any damage done (excluding normal wear and tear);
• Upon separation from the Company, I will return the item(s) issued to me in proper working order (excluding
• normal wear & tear);
• I will replace any items issued to me that are damaged or lost at my expense;
• I authorize a payroll deduction to cover the replacement cost of any item issued to me that is not returned for whatever reason, or is not returned in good working order.

~Nothing follows~