Equipment Lease Request

(DFI Form 2312)

Estimated Cost: USD

Lease Initiation Fee: %

Term: Years

Lease Initiation Fee:

Monthly Payment:

Lease Cost Factor:

Total Payments:

Annual Payment:

Request Justification:

Organization Requesting Equipment:

Equipment Type

Shipping Address:

Funding Notes: (Source of Funds, Term of Availability, Alternate Plan with specifics for Resource Management Approval)

Funding Type:

For Single Year with Option Years, Lease Payout is Required in the last month of the FY. Year 1 Estimate:

Acknowledgment: The signatures on this form indicate a request for contract modification. Specifically, to amend the base lease agreement by addition of the above requested equipment. The Logistician signature acknowledges the equipment will be entered into the property record and tracked while in possession of the using organization. The Manager, Business, and RM signatures certify to the contracting officer or their representative that funds and funding sources identified are appropriate and expected to be available for the full term of the lease. The requesting organization is responsible for providing lease payments regardless of changes to the specific plans. The completed form authorizes Dragonfly Innovations or its assigns to procure equipment for lease to the Customer.

If NO then provide Current Lease Reference Number:

New Lease?:

Yes No

Specialized kit:

No Yes

Multi-Year Single Year with Option Years

Role

Name

Email

Direct Phone #

Signature

User:

Manager:

Logistician:

Business:

RM:

KO/COR: