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Revision 01-2015 (Form 000-002)
COMPANY PROPERTY RECEIPT
Employee Name: ___________________________________ Social Security#:_____________________
(Last,) (First) (MI)
Client Company: __________________________________________Client #: _____________________
I ______________________________acknowledge the receipt of the company property listed below
along with the value of each item. I understand that each item must be returned to Elite Payroll Solutions in
good working condition on or before the date of my last day of work at Elite Payroll Solutions or at any time as
requested by Management. Where permitted by applicable laws, Elite Payroll Solutions may withhold from
the employee’s check or final paycheck the cost of any items that are not returned when requested. Elite
Payroll Solutions may also take all action deemed appropriate to recover or protect its property.
Employee Signature: ___________________________________ Date: _____________________________
Witness Signature: ____________________________________ Date: _____________________________
_________________________________________________________________________________________
Company Property Received By: _______________________________________ Date: ________________
Item Description
Serial / Identification Number
Value
Computer ( ) Laptop ( ) Desktop
$
Wireless Card
$
Laptop Adapter
$
Laptop Carrying Case
$
Cell Phone
$
Cell Phone Accessories
$
Company Credit Card(s)
$
Company Keys
$
Company Gas Card(s)
$
Client Lists
$
Client Documents
$
Promotional Items
$
Company Tools
$
Uniform(s)
$
Company Vehicle Inspection
$
$