Tool Loan #: _______________ Approved: __________________

Name of Owner: __________________________________________

Name of Item: ____________________________________________

Duration of loan: _________________________________________

Item Serial #: ____________________________________________

Estimated Replacement Cost: ______________________________

Item Description/Accessories:

Dayton Diode Expenses:

User Expenses:

Owner Expenses:

Photos of Item:

Links to documentation/tutorials:

I, ___________________________, am loaning the _____________________ listed above per the above terms to Dayton Diode in order to help kickstart the most awesome hackerspace in Dayton.

Member Signature: ____________________________________ Date: ____________

Officer Signature: _______________________________________ Date: ____________

Licensed under Attribution-Noncommercial-Share Alike 3.0 Unported.

Form consensed on by Dayton Diode membership on Feb 3, 2011.

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