MAS Equipment Loan Request Form

Equipment Loan Request Form
* Allow a 2-week period to process equipment requests.
Full Name:*

First NameLast Name
Phone Number:*
Please enter a valid phone number.
Email Address:*
example@example.com
Institution:*
Role in Institution:*
Shipping Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Equipment Details
For a full list of equipment inventory, click here.
Item(s) Requested*

Environmental Monitoring: Elsec 765C UV + LoggerEnvironmental Monitoring: HOBO MX1101Environmental Monitoring: HOBO UX100-023ADigitization: ScanSnap SV600Digitization: Epson Perfection V600 Photo ScannerDigitization/Events: Canon Rebel T7 Digital CameraDigitization/Events: Canon EOS Rebel T5iMicrophone: RØDE Wireless GoMicrophone: RØDELink FilmmakerMicrophone: Sennheiser Lavalier MicAudio Recorder: Zoom H1Audio Recorder: Zoom H6Video Recorder: Zoom Q4Other
Other (if item not listed, or not sure what exact equipment is required)
Purpose of Loan (brief description of project and equipment’s use):*
Duration of Loan:*
(allowance of 2-4 weeks, anything above requires approval from MAS)
Project Start Date:*

MonthDayYear
Project End Date:*

MonthDayYear
Should be Empty:

Equipment Loan Request Form