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2. ALL REQUESTS MUST BE SUBMITTED 30 DAYS IN ADVANCE.
   ALL REQUESTS MUST BE SUBMITTED TO THE TRAINING COORDINATOR.
   SUBMITTING A REQUEST IN NO WAY GUARANTEES EQUIPMENT WILL BE AVAILABLE.
   ALL CLASSES TAUGHT AT THE TRAINING CENTER WILL HAVE PRIORITY.
   ALL EQUIPMENT MUST BE RETURNED IN CLEAN CONDITION.
   AGENCY/RESPONSIBLE PERSON WILL BE RESPONSIBLE FOR ANY DAMAGES OTHER THAN NORMAL USE.
   ALL EQUIPMENT MUST BE PICKED UP AND RETURNED DURING NORMAL BUSINESS HOURS.
   ANYONE/AGENCY NOT PROMPTLY RETURNING EQUIPMENT MAY LOSE THE PRIVILEGE OF USING THE TRAINING CENTER EQUIPMENT.
   ALL FEES (IF ANY) MUST BE PAID PROMPTLY.
   ALL EQUIPMENT MUST BE CHECKED OUT BY PUBLIC SAFETY PERSONNEL.
   
4. Name of Organization Requesting Equipment*
5. Name of Person Responsible for Equipment*
7. Phone Number of Person Responsible*
8. List second phone number if available
10. Requested Equipment (include number of items - EX: two long backboards)
12. Date Equipment Will be Picked Up
    Date Equipment Will be Picked Up
13. Data Equipment will be Returned
    Data Equipment will be Returned
15. Class that Equipment will be used for
16. Address Where Class will be held
18. Franklin County Department of Public Safety • 1488 Franklin Street • Rocky Mount, VA 24151 • PHONE: 540-483-3091 • FAX: 540-483-3086
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field