Computer Inventory Check-Out

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Captcha ^✻ What is 6 + 7?

Students Name ^✻

Insurance Plan ^✻

Plan A - $64

Plan B - $55

Plan C - No Insurance/Take Home Only

Paperwork Only - Stays at School

Will Buy Insurance Later

Date Purchased insurance Plan ^✻

Month

Day

Year

Computer Serial Number ^✻

Computer Asset Number ^✻

Charger Number ^✻

Date Checked-Out to Student ^✻

Month

Day

Year

Year of Graduation ^✻

Extra Description