Company/Squad Name*Choose Company/SquadCO1CO2CO3CO5CO7CO8CO9CO10CO11CO12CO13CO19SQ2SQ3SQ4SQ5SQ6SQ7SQ8SQ9SQ12SQ13SQ14SQ19Basic InformationSerial Number* LID Number* Member From* Radio Number* Member To* Radio Number* This radio includes one battery and one AC charger and the following equipment if checked:extra radio equipment carrying case and strap belt clip speaker mic Consent* I acknowledge, confirm, and agree to the stipulations below*I hereby acknowledge receipt of the above listed portable radio issued to me by my company/squad on behalf of Bedford County Fire & Rescue (BCoFR) and acknowledge, confirm, and agree that: 1. This radio and all accompanying equipment is the property of BCoFR and may be inspected or recalled at any time; 2. I am responsible for the care and safekeeping of this radio and accompanying equipment and may be liable for damages if lost or damaged and negligence on my part is determined at the sole discretion of BCoFR; 3. I will use this radio and equipment for official BCoFR business purposes only and will follow all applicable rules, regulations, and guidelines; 4. I will promptly report the loss or damage of this radio and/or equipment to my company/squad and BCoFR; and 5. No repairs, alterations, or changes of any type shall be made to this radio and/or equipment other than by BCoFR authorized persons, including the addition of stickers, markings, or any other item or means.Name* First Last Date* MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged.