Commitment Agreement

Staff Name: __________________________________

Employee Number: __________________________________

EQUIPMENT DETAILS:

Date Received: ____________________

ITEM QUANTITY

Other: ____________

*Date Returned: ___________________

* Returns must be made within 2 days of the return date being confirmed.

Agreement & Declaration:

I acknowledge it is my responsibility to transport the above equipment from Pure premises to

my home address and that I am also be responsible for returning the equipment from my
home address back to the designated Pure premises.

I acknowledge that this equipment is for my own personal use at home only and not to be
shared or used elsewhere.

Should the equipment be lost or damaged beyond repair I agree that I will replace it at my
own personal expense.

The equipment remains the property of Pure and is to be returned within 2 days or the return
date being confirmed or upon resignation/termination.

Staff Signature: ____________________________________________

Date: ____________________________________________