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Operations Request

Please enter 1 request per address.

Kiosk Relocation Form (same location)

Request submitted by:

Current Site Information

Address

POC Phone

POC First Name

POC Last Name

POC Email

Pickup Request Date

Select Type of Kiosk

How Many Kiosks

Pickup Preferred Time

Details about relocation:

Serial Number

Contact

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8640 University City Blvd
Suite A3 #215
Charlotte, NC 28213

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