VCOM Institutional Policy and Procedure Manual

DETAIL EQUIPMENT REQUEST TO TRANSFER (Must be completed for each equipment item)

Barcode and/or old tag # Description Manufacturer Model # Serial Number Grant/Contract Number Purchase Price

Estimated Value:

Responsible Division

Condition:

Current Location

For Office Use Only:

Acquisition Method: __________________

Acquisition Date: ______________________

Title: Approved for Transfer:

☐ Yes

☐ Not Approved

Barcode and/or old tag # Description Manufacturer Model # Serial Number Grant/Contract Number Purchase Price

Estimated Value:

Responsible Division

Condition:

Current Location

For Office Use Only:

Acquisition Method: __________________

Acquisition Date: ______________________

Title: Approved for Transfer:

☐ Yes

☐ Not Approved