Form Equ-0004w - Equipment Reservation Form Page 2

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Outdoor Equipment Reservation/Fee Agreement
Quantity
Item
Accounting
Price
Recap
4 person tent (8’ x 8’) $5 per Day or $9 for a Weekend
6271-046-700
Chuck box
$3 per Day or $6 for a Weekend
Sewing Machine
$4 per Day per Item (Balboa Site)
For Techbridge Reservation, Please E-Mail
$5/ girl per session Kit
Engineers to the Rescue Kits (Balboa Site)
*1.Design Your Tools/Wind-Powered Crank
*2.Clean this Water/Tune in Techbridge
*3.Give Me Shelter
*4.Car to the Rescue
Design Time (Balboa Site)
$5/ girl per session Kit
*1.Design Your Toy/Toy Prototyping
*2.Pencil Bag Design
*3. No Cookie Crumbles
*4.The Business
Damaged Equipment
8520-046-700
Total due upon pickup
Deposit fee
Paid by cash/check/credit card
**************************************************************************************************************************************************************
I the undersigned agree to return the equipment reserved on the above date in the same condition as received. I also agree
to pay for lost or damaged equipment within two weeks of the Return Date. I understand that I am required to leave a security
deposit for items replacement cost. The deposit will be refunded within two weeks from the Return date if all items are
returned in satisfactory condition.
Received
Date Stamp
Signature_________________________________________
Credit Card:  Payment $__________
 Security Deposit $__________
 Visa
 MasterCard
 Discover
 American Express
Credit card # ______________ ______________ ______________ ______________
Expiration date ____________
Print name _________________________________________ Signature ________________________________________________________
This program equipment is provided as a service to the membership and is funded by the Girl Scout Cookie Sale, United Way and Annual Giving.
MC:cc
EQU-0004W 3/31/15*

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