Falcon Dollars Card Reader Reservation Form
This form must be completed in it's entirety and submitted to the Falcon Exchange, 2nd Floor ECC, with
wet ink signature(s), no later than 3 business days prior to the rental request period.
Campus Event
Lost Films
Other - Please Specify
Sponsoring Organization
Student Activity Board (SAB)
Other - Please Specify
Location of Event
Description of Event
Date and Time of Event
Date
Date
Beginning Time
Beginning Time
Ending Time
Ending Time
8 Digit Organization and Account Number
Contact Details & Signature
The undersigned individual(s) of the above Sponsoring Organization understand and agree to the Falcon
Dollars Card Reader Rental Policy as stated on the Falcon Exchange web site. Failure to adhere to this policy
may result in loss of future Card Reader Reservation privileges. It is further understood that damaged or lost
equipment will be charged to the individual and/or the Sponsoring Organization.
Faculty/Staff Sponsor
Faculty/Staff Phone
Faculty/Staff Signature
Faculty/Staff E-mail
Student Name
Student Phone
Student Signature
Student E-mail
For Office Use Only:
Date Submitted: _____
Reader Box # _____
Transmitted to Accounting: _____
This form last updated by Lora A. Harper, CPA on October 31, 2014
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