Equipment Disposal Form
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client's Name
*
First Name
Last Name
Equipment Description
*
Facility
*
Please Select
Ben Street
Empowerment Center
Mission View
Ninth Avenue
Orchard View
Offsite Residential
How is it to be disposed of?
*
Returned
Discarded
Consignment
Important
NO ITEM CAN BE DISCARDED UNLESS THIS FORM IS RETURNED, FULLY SIGNED AND APPROVED, TO THE LEAD. Failure to follow this can result in discipline up to, and including, termination of employment.
Consignment Instructions
If the request for disposal is approved and the item is to be consigned, then the folllowing occurs: 1) The thrift store manager will look at the item and determine a value 2) The lead will fill in the Consigrnment Form, signed by the client, and delivered with the item to the store manager
Reason for Disposal
*
House Manager's Name
*
First Name
Last Name
House Manager's Email Address
*
Please Select
bengh@mme-mt.org
ec@mme-mt.org
msvgh@mme-mt.org
navgh@mme-mt.org
orvgh@mme-mt.org
osr@mme-mt.org
Email
example@example.com
Acknowledgement
By signing this form I acknowledge that all information is correct and that no action will be taken with the item until the approval process has been completed and approved by the Consumer Finance Department.
House Manager's Signature
*
Submit
Should be Empty: