Request Loan from Housekeeping

Please complete the following to borrow equipment from Housekeeping Services.
*Required Fields

Requestor Information:
First Name:* Last Name:*
Email:* Telephone:
FAX: Building:
Floor#: Room#:
 ?  Customer ID:* Approved:
When equipment is needed:
Delivery Date:* Delivery Time:*
Pickup Date:* Pickup Time:*

Items to Borrow Quantity Comments
Trash Cans
Hand Trucks
Moving Lifts
Pinch Bars

If you have any additional comments, provide them in the space below: