Alternatives to Dissection Lending Agreement Form Please read the following conditions for participation in ESEC’s Loan Library Program. If you agree to the conditions, please sign and date the agreement. Please enter credit card information for amount indicated. There will be no charge to you UNLESS the item(s) are not returned to our office by the date agreed upon below OR are returned damaged or broken. In such cases, the full cost of the item(s) will be charged. ESEC is not responsible for items lost or damaged due to shipping. Extensions may be possible. Requests can be made by speaking with an ESEC staff member who will confirm the extension to you in writing. All items must be returned in the condition in which you received them. Should you receive an item that appears damaged or broken, please let us know immediately. Loan items must be properly packaged (with the same or similar packaging material) AND INSURED upon return to ensure their safe delivery. Please complete all the following information and MAIL (or FAX 617-523-7925) to: ESEC LIBRARY LOAN 333 Washington Street, Suite 850 Boston, MA 02108 617-523-6020   DATE   Borrower’s Name   Address 1 Address 2   City, ST, ZIP   Phone Number   E-mail Address Visa MasterCard   Method of payment   Credit Card Number   Expiration Date   List items to be borrowed.   Date Needed By.   I agree to the above conditions and certify that the preceding information is correct. Signature_____________________________ Date_________________________________