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Person authorized to accept materials upon return:
Name:
Contact information:
Acknowled eg menta
STAFF USE ONLY:
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I, the undersigned, certify that I have full legal power to execute said agreement and agree to adhere
to all of the above terms and conditions.
Lender:
Signed on IU / 2 / 13 by
Print name: �cK /1/
Borrower:
Signed on _/
Print name:
� by.
To be completed upon return of loaned materials:
Returned:
Signed on / /_ by
Print name:
Return accepted:
Signed on /_
Print name:
/_ by