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Operations Request

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Kiosk Replacment

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Current Site Information

Address

POC Phone

POC First Name

POC Last Name

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Pickup Request Date

Select Type of Kiosk(s)

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Pickup Preferred Time

Details about relocation:

Old Kiosk Serial Number(s)

Replacement Kiosk Serial Number(s)

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

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