Panasonic AG-DVX100B - Outdoor Antenna Grounding; Lightning and Power Line Safety; Overloading and Liquid Hazards; Servicing and Repair Precautions

Equipment inventory and cost
Portable camera 1 2 3 4 5 6 7
Name _______________________________
Drivers license # _____________________
Address _____________________________
City __________________
Zip _________
Phone (H) ____________________________
Cell _______________________________
Project description
_______________________________________________________
________________________________________________________________________
____ AG-DVX100B camcorder
$
3995.00
____ Tripod mount and screw
$
40.00
____ AC power, adapter and cord
$
160.00
____
Lens cap
$
25.00
____ Operations manual (quick/full)
$
10.00
____ Portabrace camcorder case
$
275.00
Camcorder accessories
____
Panasonic CGA-D54 batteries
$
190.00
____
25’ AC extension cord
$
10.00
____
XLR microphone cables
$
25.00
____ Headphones
$
10.00
Microphones
____
Electrovoice RE-10 HH mic
$
197.00
____
Sony lavalier microphone, clip, case
$
195.00
____ Wireless mic #____ (handheld/lav)
$
3000.00
____ Shotgun mic ($500)/boom ($800)
$
1300.00
____ Manfrotto 745B/501 tripod
$
385.00
____ Manfrotto tripod bag
$
65.00
____ Bogen 3254 dolly
$
245.00
Other:
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
I assume full responsibility for this equipment and will be liable for damage or loss incurred while the equipment
is checked out to me. I understand the equipment must be returned at the agreed upon time and the equipment
cannot be used for commercial, money-making or personal use. I may be subject to suspension of community
television privileges or assessed a rental charge if the preceding rules are not followed.
White copy: Studio Yellow copy: CTV Manager Pink copy: Producer
Signature
______________________________________________________
NORTHWEST COMMUNITY TELEVISION PORTABLE CAMERA CHECKOUT FORM
____ Lowel light kit
#____
$
1225.00
Includes 3 Omni lights, 3 barndoors and screens,
3-16’ power cords, 3 Omni light stands, light case
____ Umbrella
$
40.00
____
Lampak
$
14.50
____ EKB spare bulbs
$
30.00
____
Rifa light kit
#____
$
950.00
Includes 1 Rifa Lite 55 with diffuser panel and bag,
1 Pro-light with barndoor and gel frame, 2-16’ power
cords, 2 light stands, light case
____ Lampaks (DP/ViP)
$
14.50
____
DP spare bulbs
$
20.00
____
ViP spare bulbs
$ 28.00
Extras
____
Accessory bag
$ 25.00
____
Tri-RCA cable
$ 15.00
____
Monitor
$ 100.00
____ Mic
stands
(desktop/oor)
$ 25.00
____ Power strip
$
7.00
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
Checkout date/time: ___________________
Check in date/time:
__________________
Staff initials:
Call 763.533.8196 x293 if you’re going to be late.
Su 12:30-6:30pm | M-Th 8:30am-11pm | F-Sa 8:30am-5:30pm
Staff initials:
— VOLUNTEERS COMPLETE THE SHADED AREA — VOLUNTEERS COMPLETE THE SHADED AREA —
763.533.8196
Portable camera checkout form
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