You must have JavaScript enabled to use this form. By signing this agreement, you are acknowledging that you have rented a camera from the Photography Program of the Art Department of CSUSB. The fee for renting the camera for the term is $25. You are responsible for the camera, lens, and any related accessories. If lost, stolen, or damaged you are responsible for the replacement value - $200 - $500. Lost lens caps are subject to a $5 fee. Please fill out the student information section below, then take this form to the Bursars office to pay the $25 fee. CAMERAS NOT RETURNED BY THE LAST DAY OF CLASS WILL RESULT IN YOUR RECORDS BEING HELD. Must show payment receipt to receive camera. NO CASH IS ACCEPTED. Please allow 24 hours to process and prepare your camera for rental How-to Tutorial Video Student Information Name Address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Phone Number Student ID # Email Address Date Requesting to pick up equipment Tuesday 10:30am 11am 11:30am 12pm 12:30pm 1pm 1:15pm Wednesday 12:30pm 1pm 1:30pm 2:30pm 2pm 3pm 3:30pm 4pm 4:30pm 5pm 5:15pm Thursday 10:30am 11am 11:30am 12pm 12:30pm 1pm 1:15pm Friday 10am 10:30am 11am 11:30am 12pm 12:30pm 1pm 1:30pm 2pm 2:30pm 3pm 3:30pm 4pm 4:15pm Class Term Instructor Student Signature Sign above Date Signed