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Operations Request
Please enter 1 request per address.
Kiosk Relocation Form (same location)
Request submitted by:
Choose your name
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
How Many Kiosks
Pickup Preferred Time
Details about relocation:
Serial Number
Send
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