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. Pay Photography Equipment Fee How-to Tutorial Video Camera Type 35mm Digital 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 9:30am 10am 10:30am 11am 11:30am 12pm 12:30pm 12:45pm Friday 9:30am 10am 10:30am 11am 11:30am 12pm 12:30pm 1pm 1:30pm 2pm 2:30pm 3pm 3:30pm 4pm 4:30pm 4:45pm Class Term Instructor Student Signature Sign above Date Signed Camera Model Requested Lens Model Requested Additional Accessories