Asset Acknowledgement Form

CCI Asset Acknowledgement Form

This form is an acknowledgement for CCI equipment use for Employee Partners and Leadership Team members.

Name: Location: (City, State) Contact Phone Number: (home or cell) Email: CCI Manager: Computer Type: Computer Serial Number: Product ID: Monitor Type Monitor Serial Number Mouse/Keyboard Info Any Comments: (condition, etc.)

If Employee Partner, please complete the information below:

IBM Serial Number: IBM Manager: Name of Account Supported:

I, ______, understand the guidelines and policies for CCI equipment use. I will only be using CCI assets for business purposes only. Any software or hardware installed is required to have prior approval before installation. Upon my termination with CCI (whether voluntary or involuntary), I will return all above mentioned assets within 24 hours. Failure to do so will result in a penalty of $1,500. In addition, I acknowledge that I will not receive my last paycheck, unless I return the above mentioned assets. Should final paycheck not cover expenses, CCI retains the right to file for reimbursement through court proceedings.

______Print Name

______Signature ______Date

______Manager Name

______Signature