Barksdale/Cloverdale Neighborhood Association, Inc.

BCNA EQUIPMENT LOAN AGREEMENT FORM

Oct 23, 2006

BARKSDALE/CLOVERDALE NEIGHBORHOOD ASSOC, INC.
1505 S. Barksdale
Memphis, TN 38114
Phone 274-9050
Fax 901-274-9050
Home Phone 901-274-8856

NEIGHBORHOOD EQUIPMENT LOAN AGREEMENT


I, _____________________________________, have requested to borrow lawn equipment
belonging to the Barksdale/Cloverdale Neighborhood Association, Inc. and purchased by a
grant from the Memphis Area Neighborhood Watch, Inc. I agree to return this equipment
in proper working order by 9 p.m. on ____________________. If this equipment isn?’t
returned by the time stated I understand that it may be considered stolen and late fees may
apply. Authorities may be notified at the cost of the Borrower.

In addition, I accept full and total responsibility for this equipment. I agree to replace or
repair the equipment if damaged or stolen within two weeks of such incident. I understand
that this equipment is to be used at _______________________________________ only and
not to be taken to any other location without prior permission from the officers of the
BCNA. Gas is the responsibility of the borrower and is not provided by the BCNA.

Equipment Information

Equipment _____________________________
Serial Number _________________________

Model Number _______________ Condition _______ Oil Checked _______

Date Borrowed _____________________ Time __________ a.m./p.m.

Borrower?’s Information

Name ________________________________________ Phone __________________________

Address of equipment use _________________________________________________

Driver?’s License No. .__________________________ Member ______ Non-Member _____

Social Security No. _____-________-________ Donation Amount __________________

_____________________ ________________
Signature of Borrower Date

_____________________________ __________________
BCNA Representative Title