Historical Artifact Incoming Loan Agreement printable pdf download

Rotary Club of Joliet

Club #78 · District 6450

HISTORICAL ARTIFACT INCOMING LOAN AGREEMENT

Please complete form (including signature & date) and bring with you when you drop off your item/s to:

Ed Dollinger, Edward Jones – 735 Essington Road, Suite 101, Joliet, IL 60435 - (815) 744-2127

Lender:

______________________________________________________________________________

Address:

______________________________________________________________________________

Telephone:

(______)____________________ Email: ___________________________________________

Period of Loan Agreement: ___________________________________________________________________

Purpose of Loan:

Loan #

Accession #

Description

Value

Insurance coverage, if necessary, must be provided by the lender (initial one):

____ Lender

____ Insurance not required

The conditions of this loan as listed on the next page are understood and acceptable.

_________________________________________

__________________________________________

Lender's signature

Date

Joliet Rotary Club

Date

{Rotary use only} Condition Report (use extra sheets if necessary) + Take Photos: __________________________

_____________________________________________________________________________________________

{Upon return} The object(s) described above have been returned in satisfactory condition.

__________________________________________________________

Lender's signature

Date

Historical Artifact Incoming Loan Agreement