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Operations Request
Please enter 1 request per address.
Kiosk Relocation Form (same location)
Request submitted by:
Choose your name
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Current Site Information
Address
POC Phone
POC First Name
POC Last Name
POC Email
Pickup Request Date
Select Type of Kiosk
Select Type of Kiosk
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How Many Kiosks
Pickup Preferred Time
Details about relocation:
Serial Number
Send
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