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Key Request Form

2. Name or Organization

4. Phone

5. Email

7. Key Requested

8. Access

10. Key Requested

11. Access

13. Key Requested

14. Access

16. Key Issue Agreement

18. In return for the loan of the keys above, I agree: (please initial each)

20. (Initials)

21. There is a $50 deposit fee per key ring. Deposit will be returned when key(s) are returned.

    There is a $50 deposit fee per key ring. Deposit will be returned when key(s) are returned.

23. (Initials)

24. Not to give or loan the key to others.

    Not to give or loan the key to others.

26. (Initials)

27. Not to make any attempts to copy, alter, duplicate, or reproduce the key.

    Not to make any attempts to copy, alter, duplicate, or reproduce the key.

29. (Initials)

30. To use the key for authorized purposes only.

    To use the key for authorized purposes only.

32. (Initials)

33. To safeguard and store the key securely.

    To safeguard and store the key securely.

35. (Initials)

36. To immediately report any lost or stolen keys.

    To immediately report any lost or stolen keys.

38. (Initials)

39. Produce or surrender the key upon official request.

    Produce or surrender the key upon official request.

41. (Initials)

42. If the key is lost, stolen, or not surrendered when requested, a charge that reflects the cost of changing all locks affected may be assessed.

    If the key is lost, stolen, or not surrendered when requested, a charge that reflects the cost of changing all locks affected may be assessed.

44. eSignature

45. Date
    Date

47. Deposit

48. Expected Return Date

50. Released By:

51. Date
    Date

53. Return Date
    Return Date

54. Received By:

56. Deposit Returned

    1. Yes
    2. No

57. Date Returned
    Date Returned

59. If not returned, reason:

    1. Lost
    2. Stolen
    3. Broken
    4. Other

60. If other, please explain:

Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field