I wish to apply for a loan under the Personal Computer Loan Program to purchase a computer, printer, peripheral equipment and/or software solely for my personal or professional use.

I have reviewed and understand the program's guidelines.

I request a loan in the amount of:($1500 max)

Employee Name:
Employee Home Address
Employee Department:
Employee ID #:
Employee Phone:Home Phone:
Employee Email Address:
please enter the complete email address (ie user@louisville.edu)
Date: