WHITEWATER COMMUNITY TELEVISION EQUIPMENT CHECK-OUT Name ______________________________ Certif. No. ___________ Address _________________________________________________ ________________________________________________________ Home Phone __________________Work Phone ________________ Organization _____________________________________________ Org. Address _____________________________________________ Org. Phone No. ___________________________________________
FOR WCTV USE ONLY EQUIPMENT RESERVED FOR: F R O M T O DATE: _______________ TIME: ________________
DATE: ________________ TIME : ________________
APPROVED DENIED BY: __________ DATE: _________
Requested for: REASON: ____________________ From: Date __/__/__ Time __:__ (AM/PM) ______________________________ To: Date __/__/__ Time __:__ (AM/PM) ______________________________ Production Location (s) ______________________________________ __________________________________________________________________________________ Location Phone _____________________________________________________________________
In consideration for the use of television production equipment provided by WCTV for access programming, I hereby agree to the following: 1. I hereby acknowledge I have received, read, and understand WCTV Rules and Procedures. 2. I agree to exercise reasonable care in use of the equipment and at all times keep the equipment in a safe place. I agree to pay the costs of any repair or replacement of equipment or materials that are damaged or lost as a result of, but not limited to, mistreatment, accident, neglect, misuse, loss, theft or vandalism while the equipment is in my possession or control. I agree to return the equipment at the time stated. I agree to pay reasonable attorneys fees and collection costs incurred by WCTV in collecting or attempting to collect any sums due under this agreement. I agree that the intended use of the equipment is to produce programming for the Whitewater Community Television access channels, and that the equipment will not be used in any way for personal profit or remuneration. I further agree that the equipment will not be used in violation of any City, State and Federal Laws. False or misleading statements in this application are grounds for forfeiture of the right to use WCTVs equipment and facilities.
Use of the equipment is to produce the following program: ___________________________________ C HO EU CT K C HI EN C K I hereby accept this equipment in good working condition. All exceptions are listed below: ____________________________________________________________________________ ____________________________________________________________________________ User Signature ____________________________ Date: _____________ Time: ____________ WCTV Staff Signature ______________________Date: _____________ Time: ____________ Equipment has been returned in good working condition. All exceptions are listed below: ____________________________________________________________________________ ____________________________________________________________________________ User Signature ____________________________ Date: _____________ Time: ____________ WCTV Staff Signature ______________________Date: _____________ Time: ____________

SONY RF-COLOR ADAPTER SONY SEG-1 GENERATOR SONY SL-5000 SONY SLV400 SONY SVO-1610 SONY TV-115 SONY TV-970 SONY UV-1962 SONY VO-2600 SONY VTR-1000R SONY/ADMIRAL 22OUA TB-920U TEKTRONIX 528 WAVEFORM MONITOR ZENITH MONITOR ? 115267