ADP Individual Authorizer Loan Equipment Request

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Instructions

  • You must be an Individual Authorizer (OT or SLP).
  • Read this instruction sheet, complete the form below, and select kit (max. 2) or specific items (tick appropriate boxes).
  • Orders are not accepted over the phone.
  • The loan period is three weeks from the date of shipment. Loan extensions are permissible and depend on availability.
  • Failure to return equipment on time impacts your colleagues and their clients. Repeated offenses may result in the removal of loaner privileges.
  • If you have questions please contact info@mail.cepp.org

Shipment information

  • Devices are shipped to you at CEP’s expense.
  • Returned equipment expenses are covered by CEP when you attach the Purolator return waybill included with the shipment and call Purolator (1-888-744-7123) for pick up confirming an occupied location.

Receipt Information

  • The packing slip must be signed and faxed to CEP immediately following receipt (416-698-3793). If any equipment is missing please note it on the packing slip.
  • The equipment is your responsibility and shouldn’t be loaned to anyone else.

Return Information

  • Clean the equipment prior to return.
  • Equipment must include the original packing slip or photocopy.
  • Contact CEP customer service (see shipping information)

Important NOTE

  • Some loan items are ABOVE THE ADP MAXIMUM PRICE. This is noted for the specific items on the loan form below. We are hoping the IA ADP Product Manual will be updated shortly.

Commonly Used Vendors

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ADP Individual Authorizer Loan Equipment Request Form

MM slash DD slash YYYY
IA Name(Required)
IA Address(Required)
I understand that I can have this device/kit for a period of 3 weeks effective from the date of shipment from CEP. I understand that CEP will cover the cost of shipping if protocols are followed, however if not I will pay the shipping.
(Required)
MM slash DD slash YYYY
From
MM slash DD slash YYYY
To

Kit #1 – Quick Messaging / Simple Speech Generating Devices

Kit #2 – Simple Speech Generating Devices

Kit #3 – Voice Amplifiers

Kit #4 – Artificial Larynx

Kit #5 – Switch and Device Mounting Kit

This field is for validation purposes and should be left unchanged.