CSUS/MUNICIPAL LEASING PROGRAM
LEASE/PURCHASE REQUEST FORM
COLORADO STATE UNIVERSITY
IV. Approval Signatures
Request Originator: ______________________________________
Date _________________
Department Head: _______________________________________
Date _________________
The addition of this lease payment to the total financial obligations of the college or unit can be accommodated within the projected resources of the college or unit.
Dean: _________________________________________________
Date _________________
College or Unit
Vice President: __________________________________________
Date _________________
CSURF USE ONLY:
IF APPLICABLE
Contract and Grant Approval: ___________________________________________________
Contract Administrator
Date _________________
Computer Purchase Approval: ___________________________________________________
Director of ACNS
Date _________________
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Lease Officer: _________________________________________________________________
Date _________________
Equipment acquisition, leasing and financing through CSURF on terms negotiated by me and reflected above, approved by the undersigned. The undersigned, as the designated and authorized representative of the University pursuant to a Resolution of the Board of Governors of the Colorado State University System, hereby declares the University's official intent to reimburse itself for all expenditures made by the University in connection with the acquisition of such equipment from the proceeds of a tax-exempt lease/purchase transaction which may be completed after such expenditures are made.
Vice President for Research, Colorado State University:
____________________________________________________________________________
Date _________________
Vice President of University Operations, Colorado State University:
_______________________________________________________
Date _________________
Administrative Fee Policy
Should the lease application be cancelled prior to funding, CSURF reserves the right to collect a minimum fee of $75.00.
Equipment acquired through this lease/purchase agreement is to be for the sole benefit of Colorado State University and is to be maintained by CSU.
The financial terms for lease/purchase agreements are determined by the type of equipment.
Direct all questions to:
Julie H. Birdsall
Chief Financial Officer & Corporate Secretary/Treasurer
CSURF
Room 410, USC Building
Fort Collins, CO 80522
Phone: (970) 482-2916
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