City, State, Zip ___________________________________________________________
Phone (H) ______________________________ (O) _______________________________
I, the above FSGW member, am borrowing the FSGW
Equipment [for use by the above organization] on ______________________, ______.
I received this equipment complete and in good condition. I am personally responsible for its transportation, care and use.
I will return it complete, and in as good condition as when I received it, or I will repay FSGW for all repair or replacement costs.
I will give FSGW $_____________ towards the care and replacement of this equipment upon its return on _______________________, ________.