Date of Arrival at ATR:
Optio S/N:
Origin Organization:
Origin Address:
Street 1:
Street 2:
City:
State: ---AKALAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Zip:
RMA #:
Verify the following:
IMPORTANT: IF ANY OF THE ABOVE BOXES ARE NOT CHECKED YOU SHOULD SUBMIT THIS FORM AND CONTACT LOBBYGUARD BEFORE PROCEEDING WITH ANY FURTHER STEPS WITH THIS KIOSK.
