Equipment Request Form Oct 4, 2021 Equipment Request Form Independent Producer's Name Email Address The date you would like to request the equipment for: Time you will pick up the equipment: The date you will return the equipment: Time you will return the equipment: Address Phone Number Program Title Program description Location of filming Please specify how many of each item you are requesting: Panasonic HD Tripod # Camera Batteries Hand Held Mic Lavalier Mic # (AA batteries not included) Wireless Mic # (9v batteries not included) Shotgun Mic # (AA batteries not included) Floor Mic Stand # Table Mic Stand # Mic Extension Cable Other A/V Cable If you have chosen "Other A/V Cable" Please specify A/V Cable type Audio Mixer LED Light Kit # Light Kit # Soft Box LED Camera Light Power Extension Cords Switcher package Portable Hard Drive Miscellaneous If you have chosen "Miscellaneous" Please specify the items you are requesting Camera Operators Any additional notes you wish to include in your request? Request Guidelines: 1) All requests for equipment should be made at least 2 weeks in advance. 2) Last-minute requests must be submitted no later than 4pm on Friday. 3) Requests are filled on a first come first served basis. 4) Cancellations should be made 24 hours in advance. 5) Equipment must be returned no later than 1 hour before closing. Mon-Friday by 8pm and Saturday by 3pm. 6) Failure to return equipment on time, or failure to cancel equipment when not using, will result in loss of equipment use privileges. 7) The producer is responsible for obtaining all necessary clearance arrangements PRIOR to equipment check-out. 8) Equipment cannot be taken out of Montgomery County, except as provided in Rule 3.2. I have read and agree to abide by all rules and regulations of DATV. I understand that I am responsible and will immediately replace any equipment which is lost or damage resulting from, but not limited to, misuse, mistreatment, accident, neglect or theft. I understand that I must complete this program within 90 DAYS from my final shooting date. I also acknowledge that I am responsible for obtaining all necessary releases for this program including those for any copyrighted material.